Neurodevelopmental outcome of HIV‐exposed but uninfected infants in the Mother and Infants Health Study, Cape Town, South Africa

Abstract

Abstractobjectives To compare neurodevelopmental outcomes of HIV-exposed uninfected (HEU) and HIVunexposed uninfected (HUU) infants in a peri-urban South African population. HEU infants living in Africa face unique biological and environmental risks, but uncertainty remains regarding their neurodevelopmental outcome. This is partly due to lack of well-matched HUU comparison groups needed to adjust for confounding factors.methods This was a prospective cohort study of infants enrolled at birth from a low-risk midwife obstetric facility. At 12 months of age, HEU and HUU infant growth and neurodevelopmental outcomes were compared. Growth was evaluated as WHO weight-for-age, length-for-age, weight-forlength and head-circumference-for-age Z-scores. Neurodevelopmental outcomes were evaluated using the Bayley scales of Infant Development III (BSID) and Alarm Distress Baby Scale (ADBB).results Fifty-eight HEU and 38 HUU infants were evaluated at 11-14 months of age. Performance on the BSID did not differ in any of the domains between HEU and HUU infants. The cognitive, language and motor scores were within the average range (US standardised norms). Seven (12%) HEU and 1 (2.6%) HUU infant showed social withdrawal on the ADBB (P = 0.10), while 15 (26%) HEU and 4 (11%) HUU infants showed decreased vocalisation (P = 0.06). There were no growth differences. Three HEU and one HUU infant had minor neurological signs, while eight HEU and two HUU infants had macrocephaly.conclusions Although findings on the early neurodevelopmental outcome of HEU infants are reassuring, minor differences in vocalisation and on neurological examination indicate a need for reassessment at a later age.

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 present findings did not support the expectation that pre-and post-natal HIV-1exposure adversely affect dental caries in primary teeth nor oral health related quality of life of 5-7 years old children in Uganda. In this aspect, the present study accords with some previous African studies but contrasts with others investigating aspects of HEU children's general health and developmental delays [38][39][40][41]. The caries prevalence of 5-7-year-old HEU and HUU children observed in this study is comparable to that of children in the Ugandan general child population of similar age, previously estimated to range from 38 to 65% [31,42].…”

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

“…There also could have been The present findings did not support the expectation that pre-and post-natal HIV-1exposure adversely affect dental caries in primary teeth nor oral health related quality of life of 5-7 years old children in Uganda. In this aspect, the present study accords with some previous African studies but contrasts with others investigating aspects of HEU children's general health and developmental delays [38][39][40][41]. The caries prevalence of 5-7-year-old HEU and HUU children observed in this study is comparable to that of children in the Ugandan general child population of similar age, previously estimated to range from 38% to 65% [31,42].…”

Neurocognitive and functional impairment in adult and paediatric tuberculous meningitis

“…Numerous instruments have been developed for the assessment of child development based on age, domains tested, and type (performance based, self/caregiver rating). Unlike in adult TBM, these have been extensively reviewed elsewhere in published literature including comparison of available tests and suitability for use in LMIC settings 100,101 . Although there is no consensus or consistency on the measures used to assess outcome post TBM in infants and children, ideal testing requires wide age-range; the ability to measure floor and ceiling effects as some of the children are left with very low residual function, and needs to assess fine and gross motor ability, receptive and expressive language as well as behavioural, social and adaptive skills.…”