Page 374 - SAHCS HIVMed Journal Vol 20 No 1 2019

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 8 Original Research

Neurodevelopment at 11 months after starting

antiretroviral therapy within 3 weeks of life

Authors: Background: Antiretroviral therapy (ART) started between 7 and 12 weeks of age improves
Barbara Laughton neurodevelopmental outcomes in HIV-infected (HIV+) infants, but the impact of even earlier
1
Shalena Naidoo 2
Els F.M.T. Dobbels 1 initiation is not yet described.
Michael J. Boivin
3,4
Anita Janse van Rensburg 1 Objectives: We assessed the early neurodevelopment of HIV+ infants who started ART within
Richard H. Glashoff 21 days of life.
2,5
Gert U. van Zyl
5,6
Mariana Kruger 1 Method: Participants were enrolled from the public sector birth HIV-diagnosis programme.
Mark F. Cotton Inclusion criteria included the following: birth weight > 2000 g, infant commencing ART
1
< 6 weeks and no infant cytomegalovirus disease. Antiretroviral therapy included
Affiliations: Zidovudine/Lamivudine/Nevirapine for the first 2 weeks, the latter then replaced by
1 Department of Paediatrics
and Child Health, Lopinavir/Ritonavir. Once body weight > 3 kg and gestational age > 44 weeks, Abacavir
Stellenbosch University, replaced Zidovudine. The Griffiths mental development scales (GMDS) were administered
Cape Town, South Africa at 10–12 months.
2 Department of Pathology, Results: Of 29 infants assessed, 23 (79%) were girls. Mean birth weight was 3002 ± 501 g.
Stellenbosch University, Twenty-four mothers (83%) received ART during pregnancy. Seven (24%) infants were
Cape Town, South Africa diagnosed HIV+ within 48 h of birth. Median [interquartile range] viral load (VL) at
diagnosis was 3904 [259–16 922] copies/mL, age starting ART was 6.0 [3–10] days and age
3 Department of Psychiatry,
Michigan State University, at VL suppression was 19.1 [15–36] weeks. At the GMDS assessment, nine (31%) participants
East Lansing, United States had detectable VL and 26 (90%) had World Health Organization (WHO) clinical stage
I disease. The GMDS was performed at a mean age of 11.5 ± 0.8 months. Mean quotients
4 Department of Neurology were within the average range: Global Griffiths score was 103.6 ± 10.9 and mean quotients
and Ophthalmology, on the subscales ranged from lowest 95.9 ± 13.4 for locomotor to highest 112.8 ± 11.3 for
Michigan State University,
East Lansing, United States hearing-and-language.
Conclusion: Preliminary findings in this small group suggest that early neurodevelopmental
5 National Laboratory Services,
Cape Town, South Africa scores are within the normal range in infants with perinatal HIV infection who started ART at
a median of 6 days.
6 Division of Virology, Faculty
of Medicine and Health Keywords: HIV; infants; antiretroviral therapy; neurodevelopment; paediatrics.
Sciences, Stellenbosch
University, South Africa
Introduction
Corresponding author:
Barbara Laughton, HIV-infected (HIV+) children are at risk for neurodevelopmental delay. Neurologic insults
[email protected] develop after HIV enters the brain, creating an inflammatory state affecting neuronal and astrocyte
growth and development ; the most severe manifestation being HIV encephalopathy (HIVE). HIV
1
Dates:
Received: 08 July 2019 encephalopathy rates range from 6% to 30%, with higher rates in low- and middle-income
Accepted: 18 Aug. 2019 countries especially with delayed initiation of combination antiretroviral therapy (ART). 2,3,4,5
Published: 30 Oct. 2019 These consequences place a great burden on the social and healthcare systems.

Antiretroviral therapy has decreased the incidence of HIVE, and when initiated between 3 and
6
9 months of age, it improves clinical and neurodevelopmental outcomes. 7,8,9,10 Nevertheless,
studies describing permanent deficits or lack of catch-up suggest that prevention is better than
reversal of HIVE. 11,12,13 From 2016, the World Health Organization (WHO) introduced birth testing
and recommended starting ART as soon as possible once HIV infection is confirmed. Since the
14
report of temporary remission in the Mississippi baby after very early ART, there is increasing
15
evidence that early ART in perinatally infected children improves infant outcomes. Early ART
16
Read online: can limit HIV reservoir size, and when started before 2 months of age, it is associated with fewer
Read online:
Scan this QR infected and transcriptionally active cells and less infectious virus recovery. 17,18,19,20,21,22,23,24
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mobile device How to cite this article: Laughton B, Naidoo S, Dobbels EFMT, et al. Neurodevelopment at 11 months after starting antiretroviral therapy
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to read online. within 3 weeks of life. S Afr J HIV Med. 2019;20(1), a1008. https://doi.org/10.4102/sajhivmed.v20i1.1008
Copyright: © 2019. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.
http://www.sajhivmed.org.za 367 Open Access