Page 377 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 4 of 8 Original Research

CD4 parameters at baseline) were not significant. The five counts at baseline and a longer time to undetectable VL
predictors of GMDS scores entered into the regression model compared to participants in the current study. Abacavir also
also did not show significant relationships, that is, birth replaces Zidovudine use in the CHER participants.
weight, ART start age, baseline VL, baseline CD4% and age at
first suppression. CD8 count at the time of GMDS showed a Discussion
negative correlation with personal–social (Pearson r = -0.41;
p = 0.03) and a negative trend with General Griffiths (Pearson These findings from the first 29 infants who started ART at a
r = -0.6; p = 0.06). median age of 6 days are encouraging and show potential
for normal neurodevelopmental outcomes, despite other
For growth parameters closest to the GMDS assessment, medical conditions in nine infants that may impair
head circumference z-scores correlated significantly with neurological development. These scores are well within 1 s.d.
the performance (visual–spatial) scores (Pearson’s r = 0.4; of the UK norms, and are comparable to other South African
p = 0.02) and weight z-score correlated with eye–hand infants assessed at similar ages using the GMDS 29,30,32,33,34
coordination scores (Pearson’s r = 0.36; p = 0.05). There was a (see Appendix 1, Table 3-A1 for summary of scores). This
positive trend between weight for age z-score and General finding is despite almost a third not being virologically
Griffiths score (Pearson’s r = 0.34; p = 0.07). suppressed at testing. However, VLs in this cohort indicated
low exposure to HIV because of maternal ART. 38
We compared the GMDS scores of those whose mothers had
ART for prevention of mother-to-child transmission of HIV We previously described neurodevelopmental outcomes in
(PMTCT) and those who did not and found no difference the CHER trial at 11 months. We compared children on
10
between the groups (see Appendix 1, Table 1-A1). There were delayed ART to those who started early ART at a median
also no significant differences on the GMDS scores between [IQR] of 7.7 [7.1–9.5] weeks. The GMDS scores from the
those with detectable VL and undetectable VL at the time of CHER early treatment arms are comparable to this very early
the test, despite the mean scores in the hearing-and-language
and eye–hand coordination subtests being 5 points lower TABLE 5: Comparison between study participants and Children with HIV Early
for the nine with detectable VL compared to the 20 with antiRetroviral early treatment participants. 10
undetectable VL at testing (Table 4). We also compared the Characteristics Current study CHER early ART p -
29
64
Number enrolled
following participant demographics between the detectable Age of ART initiation 6.0 [3–10] days 7.7 [7.1–9.5] weeks < 0.001
VL and undetectable VL groups: birth weight, baseline VL Median [IQR]
copies and CD4 parameters, ART start age, CD4, CD8 and Birth weight (g) 3002 ± 501 2994 ± 406 0.98
growth parameters at the time of GMDS, and found no Gestational age 37.9 ± 2.3 38.9 ± 2.3 0.06
(weeks)
difference (see Appendix 1, Table 2-A1). (3 unknown) (3 unknown)
PMTCT – mother -
Yes 24 (83%) 55 (86%)
The GMDS scores achieved by this cohort were similar to No 4 (14%) 6 (9%)
those from the CHER cohort (children on ART commenced at Unknown 1 (3%) 3 (5%)
7 weeks of age) at a mean age of 11.3 months, apart from History of prenatal 2 Methamphetamine 2 Alcohol -
10
1 Alcohol +
substance exposure
personal–social subscale, where the CHER cohort had mean methamphetamine
quotients 7 points above that of the current study population Infant baseline 2494 ± 47629 (n = 26) 5 500 942 ± 55 693 < 0.01†
VL (copies/mL)
(Table 5). Post hoc item comparison for personal–social CD4 absolute count 2090 ± 800 2062 ± 1100 0.42
showed that CHER participants were more likely to help CD4% 44.7 ± 14.2 35.2 ± 8.6 < 0.01
with dressing, hold an open cup for drinking, try to use a Time to undetectable 30.0 ± 16.6 (n = 23) 38.8 ± 8.8 0.01
VL‡ (weeks)
spoon for feeding and obey simple requests. Participants on ART regimen at the 28 Abacavir, Lamivudine, 63 Lamivudine, Lopinavir/ -
the current study were more likely to clap hands and enjoy time of test Lopinavir/Ritonavir Ritonavir, Zidovudine
an adult showing a book. 1 Abacavir, Lamivudine, 1 Abacavir, Nevirapine,
Didanosine
Didanosine
VL undetectable at the 20 (69%) 40 (62%) -
Significant differences between the two groups are shown time of GMDS test
in Table 5, with CHER having higher VLs and lower CD4 Age at GMDS (months) 11.5 ± 0.8 11.3 ± 1.1 0.16
GMDS quotient scores:
Locomotor 95.9 ± 13.4 97.7 ± 12.5 0.3
TABLE 4: Comparison of Griffiths Mental Development Scale quotients in those Personal–social 104.2 ± 14.7 111.2 ± 13.5 0.04
with and without virological suppression at testing.
Viral load at testing Detectable VL Undetectable VL p* Speech and hearing 112.8 ± 11.3 112.5 ± 10.4 0.89
n = 9 n = 20 Eye–hand coordination 105.0 ± 17.5 107.4 ± 15.8 0.66
Mean age at testing (months) 11.4 11.5 Performance 99.1 ± 16.1 100.3 ± 13.1 0.4
Locomotor 96.9 ± 13.5 95.4 ± 13.7 0.65 (visual–spatial)
Personal–social 102.2 ± 13.9 105.1 ± 15.2 0.48 General Griffiths 103.6 ± 11.0 106.2 ± 10.4 0.21
Hearing-and-language 109.2.4 ± 10.2 114.4 ± 11.6 0.32 Note: Norms from healthy British children: mean 100 ± 16. Results expressed as mean ± s.d.
Eye–hand coordination 101 ± 18.4 106.9 ± 17.3 0.46 VL, viral load; IQR, interquartile range; ART, Antiretroviral therapy; PMTCT, prevention of
mother-to-child transmission; s.d., standard deviation; GMDS, Griffiths Mental Development
Performance (visual–spatial) 97.9 ± 14.9 99.1 ± 16.4 0.94 Scale; CHER, Children with HIV Early antiRetroviral.
General Griffiths 101.8 ± 10.4 104.4 ± 11.3 0.52 †, Mann–Whitney U.
‡, For those not yet suppressed at assessment, date for suppression was allocated 2 days
VL, viral load. *, Mann–Whitney U. after assessment date.
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