Neurodevelopment of breastfed HIV-exposed uninfected and HIV-unexposed children in South Africa

Roux, Stanzi M le; Donald, Kirsten A.; Brittain, Kirsty; Phillips, Tamsin K; Zerbe, Allison; Nguyen, Kelly; Strandvik, Andrea; Kroon, Max; Abrams, Elaine J.; Myer, Landon

doi:10.1097/qad.0000000000001872

Cited by 81 publications

(119 citation statements)

References 44 publications

(57 reference statements)

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“…In Botswana, between 2010 and 2012 when only one‐third of mothers received combination ART during pregnancy and <10% of CHEU were breastfed compared to >99% of CHU, there was little evidence of differences in neurodevelopment at 24 months of age (N = 724) . However, in the era of combination maternal ART and breastfeeding in South Africa, CHEU had higher odds of cognitive and motor, although not language, delay at 13 months of age (N = 521) . Our study population and findings are closer to the South African study; however, in using more detailed language assessments for two‐year‐old children, we additionally found differences in vocabulary scores between groups.…”

Section: Discussionsupporting

confidence: 48%

“…Recent studies from the ART era, published since this systematic review, have generally found poorer neurodevelopment amongst CHEU compared to CHU. At 12 months of age, a study from South Africa found increased odds of cognitive and motor delay . At two years of age, a study from Botswana showed expressive language delay and a study from South Africa found receptive and expressive language delay .…”

Section: Introductionmentioning

confidence: 99%

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Early child development in children who are HIV‐exposed uninfected compared to children who are HIV‐unexposed: observational sub‐study of a cluster‐randomized trial in rural Zimbabwe

et al. 2020

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Introduction Exposure to maternal HIV may affect early child development (ECD), although previous studies have reported heterogeneous findings. We evaluated ECD among children who were HIV‐exposed uninfected (CHEU) and children who were HIV‐unexposed (CHU) recruited to the SHINE trial in rural Zimbabwe. Methods SHINE was a community‐based cluster‐randomized trial of improved infant feeding and/or improved water, sanitation and hygiene. Pregnant women were enrolled between 2012 and 2015. We assessed ECD in a sub‐study at 24 months of age, between 2016 and 2017, using the Malawi Developmental Assessment Tool (MDAT; assessing motor, cognitive, language and social development); MacArthur‐Bates Communicative Development Inventory (CDI) (assessing vocabulary and grammar); A‐not‐B test (assessing object permanence); and a self‐control task. Mothers and infants were tested longitudinally for HIV. We used generalized estimating equations to compare ECD scores between CHEU and CHU, accounting for the cluster‐randomized design. Primary results were adjusted for trial‐related factors that could affect measurement reliability of ECD: study nurse, age of child, calendar month of birth, sex and randomized arm. Results A total of 205 CHEU and 1175 CHU were evaluated. Mean total MDAT score was 90.6 (SD 8.7) in CHEU compared to 92.4 (9.1) in CHU (adjusted mean difference −1.3, 95% CI: −2.3, −0.3), driven mostly by differences in gross motor (−0.5, 95% CI: −0.9, −0.2) and language scores (−0.6, 95% CI: −1.1, −0.1). There was evidence that fine motor scores were lower in CHEU (adjusted mean difference −0.4, 95% CI: −0.8, 0.0) but no evidence of a difference in social scores (0.1, 95% CI: −0.2, 0.4). Mean MacArthur‐Bates CDI vocabulary score was 57.9 (SD 19.2) in CHEU compared to 61.3 (18.8) in CHU (adjusted mean difference −2.9 words, 95% CI: −5.7, −0.1). Object permanence and self‐control scores were similar between groups. Conclusions CHEU in rural Zimbabwe had total child development and vocabulary scores that were approximately 0.15 standard deviations lower than CHU at two years of age. More detailed and specific studies are now needed to unravel the reasons for developmental delay in CHEU and the likelihood that these delays persist in the longer term.

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Section: Discussionsupporting

confidence: 48%

Section: Introductionmentioning

confidence: 99%

Early child development in children who are HIV‐exposed uninfected compared to children who are HIV‐unexposed: observational sub‐study of a cluster‐randomized trial in rural Zimbabwe

et al. 2020

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“…Studies from various settings have reported that HIV exposed, uninfected children (HEU) have poorer health outcomes than HIV unexposed uninfected children (HUU) [19][20][21][22][23]. Thus, HEU children seem to be disadvantaged with respect to birth outcomes such as preterm birth, linear growth, metabolism, adaptive and innate immune systems; and increased infectious morbidity [24].…”

Section: Introductionmentioning

confidence: 99%

Caries experience and oral health related quality of life in a cohort of Ugandan HIV-1 exposed uninfected children compared with a matched cohort of HIV unexposed uninfected children

et al. 2020

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Background: Very few studies consider the oral health status and quality of life in HIV-1 exposed uninfected (HEU) children. The aim of this study was to estimate the prevalence of caries in primary teeth and its oral health related quality of life impacts in HEU children compared to HIV-unexposed-uninfected (HUU) children, whilst adjusting for confounding covariates. Methods: This study uses data from the Ugandan site of the ANRS 121741 PROMISE-PEP trial (ClinicalTrials.gov, number NCT00640263) conducted in 2009-2013 that recruited mothers with HIV-1 and their uninfected children. Of 244 HEU-children-caretaker pairs available at the end of the one-year trial, 166 were re-enrolled in the ANRS 12341 PROMISE-PEP M&S study at 5-7 years and 164 were included in this study. These were age and sex-matched with 181 HUU children-caretaker comparators. Caries experience was recorded using World Health Organization's Decayed, Missed and Filled teeth (dmft/DMFT) indices. The Early Childhood Oral health Impact Scale (ECOHIS) was used for assessment of oral health related quality of life. Mixed effects logistic regression was conducted with dmft and ECOHIS scores as outcomes and HIV-1 exposure status as the main exposure. Results: Forty-eight percent of HEU children and 60% of HUU had dmft> 0. Corresponding figures for ECOHIS> 0 were 12% of HEU and 22% of HUU. The crude analysis showed differences related to HIV-1 exposure in caries experience and oral health related quality of life. Mixed effect logistic regression analyses were not significant when adjusted for use of dental care and toothache. If caregivers' DMFT> 0, the adjusted odds ratio for caries experience (dmft> 0) was 1.6 (95% CI: 1.0-2.8) while if dmft> 0 the adjusted odds ratio for quality of life impacts (ECOHIS> 0) was 4.6 (95%

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“…Previous reviews have reported some delays in cognitive, language or motor development, [47,49,50] although to a lesser extent than in CLHIV and mainly in low-resource settings. [47] A recent study from SA found motor and cognitive delay, particularly associated with preterm birth, [51] and a study from Zambia reported a later impact on school performance. [52] However, other studies in Botswana [53] and SA [54] have not found substantial differences when compared with HIV-unexposed children, although some language impairment was demonstrated, which has also been seen in high-income settings.…”

Section: Early Neurodevelopmentmentioning

confidence: 99%

The impact of health programmes to prevent vertical transmission of HIV. Advances, emerging health challenges and research priorities for children exposed to or living with HIV: Perspectives from South Africa

et al. 2019

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Neurodevelopment of breastfed HIV-exposed uninfected and HIV-unexposed children in South Africa

Abstract: Young HEU children may be at increased risk for cognitive and motor delay despite universal maternal ART and breastfeeding; those born preterm may be particularly vulnerable.

Cited by 81 publications

References 44 publications

Early child development in children who are HIV‐exposed uninfected compared to children who are HIV‐unexposed: observational sub‐study of a cluster‐randomized trial in rural Zimbabwe

Early child development in children who are HIV‐exposed uninfected compared to children who are HIV‐unexposed: observational sub‐study of a cluster‐randomized trial in rural Zimbabwe

Caries experience and oral health related quality of life in a cohort of Ugandan HIV-1 exposed uninfected children compared with a matched cohort of HIV unexposed uninfected children

The impact of health programmes to prevent vertical transmission of HIV. Advances, emerging health challenges and research priorities for children exposed to or living with HIV: Perspectives from South Africa

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