Page 376 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 3 of 8 Original Research

TABLE 1: Demographic characteristics of participants (N = 29). TABLE 3: Clinical status at the time of neurodevelopmental assessments (N = 29).
Characteristics Result Clinical characteristics Result
Sex Female = 23 (79%) Age: Mean ± s.d. (range) 11.5 ± 0.8 months (range 10.2–13.1)
Birth weight (g) 3002 ± 501 (2150–4070) HIV disease severity: WHO categories 1 = 26 (90%)
Mean ± s.d. 2 = 1
Gestational age (weeks) 3 = 2
Mean ± s.d. (range) (3 unknown gestation) 37.9 ± 2.3 (33–41) Growth: WHO z-scores for age (mean ± s.d.)
Birth method: Vertex delivery 21 (72%) Weight -0.09 ± 0.9 (range -1.7 to 1.6)
-1.1 ± 1 (range -3.5 to 0.2)
Length
Caesarean section 8 Head circumference 0.23 ± 1 (range -1.9 to 2.4)
Mother’s age at birth (years) ART regimen 29 Abacavir, Lamivudine, Lopinavir/
Mean ± s.d. (range) 29.3 ± 5.4 (18.9–40.4) Ritonavir
History of prenatal substance exposure 2 – Methamphetamine VL undetectable, n (%) 20 (69%)
1 – Alcohol + methamphetamine
Home language 21 (70%) Xhosa CD4 closest to GMDS
Median [IQR]
6 (21%) Afrikaans Absolute count 2097.9 [743–1512] (range 863–3790)
1 Shona CD4% 33.8 [27–41] (range 18–53)
1 English
PMTCT – mother 24 (83%) Yes CD8 closest to GMDS
Median [IQR]
4 (14%) No Absolute count 1489 [1131–2437] (range 608–7551)
1 Unknown CD8% 27 [21–34] (range 13–53)
Infant age HIV diagnosis (days)
Median [IQR] (range) 6 [3–12] (0–52) CD4/CD8 ratio closest to GMDS 1.33 [0.83–1.92] (0.38–3.79)
Median [IQR]
Infant age HIV diagnosis: Current caregiver n (%) 23 (79%) mother
within 48 h 7 (24%) 1 shared mother and grandmother
within 1 week 17 (59%) 2 aunt
Infant ART start age (days) 1 foster mother
Median [IQR] (range) 6.0 [3–10] (0–21) 2 grandmother
ART regimen started n (%) 16 (55%) Zidovudine, Lamivudine, Father or father-figure present, n (%) 20 (69%)
Nevirapine Caregiver/father/father-figure
6 (20%) Zidovudine, Lamivudine, Drugs or alcohol abuse, n (%) 7 (24%)
Lopinavir/Ritonavir Housing, n (%):
7 (24%) Abacavir, Lamivudine, Brick 10 (34%)
Lopinavir/Ritonavir Informal dwelling 19 (66%)
Infant baseline VL (copies/mL) Electricity in house, n (%) 28 (97%)
Household receives social grants, n (%)
26 (90%)
Median [IQR] (n=26†) 3904 [265–16 922] (range 99–201 916)
CD4 closest to baseline IQR, interquartile range; s.d., standard deviation; GMDS, Griffiths Mental Development Scale.
Median [IQR]
Age (days) 14 [9–28] (range 0–251‡)
Absolute count 1938 [1446–2570] (range 679–3776) following: congenital pneumonia of unknown aetiology,
CD4% 43 [35–56] (range 19.6–71) intrauterine growth retardation, neonatal jaundice above
Time to undetectable VL§ (weeks from birth)
Median [IQR] (range) 19.1 [15–34] (2–53) (n = 23¶) exchange transfusion levels (resolved without exchange),
VL, viral load; IQR, interquartile range; ART, Antiretroviral therapy; PMTCT, prevention of congenital syphilis with mild hypoxia and suspected seizure,
mother-to-child transmission; s.d., standard deviation; GMDS, Griffiths Mental Development mild birth asphyxia (low birth Apgar scores and cord blood
Scale.
†, Three only had HIV PCR+ and no VL measured. pH = 7.17) and suspected hypoglycaemia (but glucose level
‡, Participant only enrolled into study at this age – only had VL before and no CD4 counts. not recorded) (these data not shown in any table).
§, VL done at baseline/diagnosis, 3, 6, 12 and 18 months.
¶, Six did not suppress by time of GMDS assessment.
The following adverse events, which could negatively impact
TABLE 2: Scores on Griffiths mental development scales (quotients) at mean age neurodevelopment, were documented before the GMDS
of 11.5 months (n = 29). assessment: six with otitis media (one had two episodes), six
Scale Mean Standard Maximum Minimum with anaemia and three with neutropenia (Zidovudine was
deviation
Locomotor 95.9 13.4 125 74 discontinued). One infant recovered fully after treatment for
Personal–social 104.2 14.7 138 72 suspected bacterial meningitis and another was hospitalised
Speech and hearing 112.8 11.3 131 85 for 6 months with pulmonary tuberculosis. Lastly, failure to
Eye–hand coordination 105.0 17.5 136 60 thrive because of poor feeding and insufficient caloric intake
Performance (visual–spatial) 99.1 15.7 133 68 occurred in one infant.
General Griffiths 103.6 10.9 123 82
Note: Norms from healthy British children: mean 100 ± 16. Adherence was calculated at a median [IQR] of 10 [9–11]
visits. Only one participant had acceptable adherence
log 3.18 (1519 copies/mL) and log 4.46 (28 649 copies/mL), percentages for all drugs at all visits. Three participants had
respectively. Another participant suppressed at 3 months, and poor adherence for more than half of the visits, with the rest
had a viral blip to 118 copies/mL at 6 months, with the VL over or under-dosing at various times. For the former, the
undetectable 6 months later at GMDS. infant would spit syrups out and caregivers were unsure
how much to replace. For the latter, the caregivers either
A number of demographic and exposure issues with potential measured syrups incorrectly or were non-compliant. This
to influence neurodevelopmental outcomes were identified. prompted clinicians to encourage treatment supporters for
These included two without antenatal care, one with an the caregivers.
unsupervised home birth and three with maternal substance
abuse: two methamphetamine and one methamphetamine Correlations between GMDS scores and possible predictors
and alcohol (over time these children were fostered by of developmental outcomes (birth weight, gestation, maternal
caring relatives). Medical problems included one each of the age, baseline VL, age starting ART, time to suppression and

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