Original Research

Neurodevelopment at 11 months after starting antiretroviral therapy within 3 weeks of life

Barbara Laughton, Shalena Naidoo, Els F.M.T. Dobbels, Michael J. Boivin, Anita Janse van Rensburg, Richard H. Glashoff, Gert U. van Zyl, Mariana Kruger, Mark F. Cotton
Southern African Journal of HIV Medicine | Vol 20, No 1 | a1008 | DOI: https://doi.org/10.4102/sajhivmed.v20i1.1008 | © 2019 Barbara Laughton, Shalena Naidoo, Els Francoise Marie-Therese Dobbels, Michael Joseph Boivin, Anita Janse van Rensburg, Richard Helmuth Glashoff, Gert Uves van Zyl, Mariana Kruger, Mark Fredric Cotton | This work is licensed under CC Attribution 4.0
Submitted: 08 July 2019 | Published: 30 October 2019

About the author(s)

Barbara Laughton, Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
Shalena Naidoo, Division of Medical Microbiology & Immunology Department of Pathology; Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
Els F.M.T. Dobbels, Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
Michael J. Boivin, Departments of Psychiatry and Neurology & Ophthalmology, Michigan State University, East Lansing, United States
Anita Janse van Rensburg, Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
Richard H. Glashoff, Division of Medical Microbiology & Immunology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University; National Laboratory Services Cape Town, South Africa
Gert U. van Zyl, Division of Virology, Faculty of Medicine and Health Sciences, Stellenbosch University; National Laboratory Services Cape Town, South Africa
Mariana Kruger, Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
Mark F. Cotton, Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa


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Abstract

Background: Antiretroviral therapy (ART) started between 7 and 12 weeks of age improves neurodevelopmental outcomes in HIV-infected (HIV+) infants, but the impact of even earlier initiation is not yet described.

Objective:  We assessed the early neurodevelopment of HIV+ infants who started ART within 21 days of life. 

Methods: Participants were enrolled from the public sector birth HIV-diagnosis program. Inclusion criteria included: birth weight >2000g, infant commencing ART <6 weeks and no infant Cytomegalovirus disease. ART included Zidovudine/Lamivudine/Nevirapine for the first 2 weeks, the latter then replaced by Lopinavir/Ritonavir. Once body weight >3kg and gestational age >44 weeks, Abacavir replaced Zidovudine. The Griffiths Mental Development Scales (GMDS) were administered at 10-12 months.

Results: Of 29 infants assessed, 23 (79%) were girls. Mean birth weight was 3002 ± 501g. Twenty-four mothers (83%) received ART during pregnancy. Seven (24%) infants were diagnosed HIV+ within 48 hours of birth. Median [IQR] viral load (VL) at diagnosis was 3904 [259;16922] copies/ml, age starting ART was 6.0 [3;10] days and age at VL suppression was 19.1 [15; 36] weeks. At the GMDS assessment nine (31%) participants had detectable VL and 26 (90%) had WHO clinical stage I disease. GMDS was performed at a mean age of 11.5±0.8 months. Mean quotients were within the average range: Global Griffiths score was 103.6±10.9 and mean quotients on the subscales ranged from lowest 95.9±13.4 for Locomotor to highest 112.8±11.3 for Hearing-and-language.

Conclusion: Preliminary findings in this small group suggest that early neurodevelopmental scores are within the normal range in infants with perinatal HIV-infection who started ART at a median of 6 days.

Keywords

HIV; Infants; Antiretroviral Therapy; neurodevelopen; Paediatricst

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