Neurodevelopmental Outcomes of Young Children Born to HIV-Infected Mothers: A Pilot Study

Abstract

Introduction: Over 15 million children who were exposed to HIV perinatally but uninfected (HEU) are alive globally, and they are faced with multiple risk factors for poor neurodevelopment. While children who are HIV-infected (HIV+) appear to have worse neurodevelopmental scores compared to children unexposed and uninfected with HIV (HUU), the evidence is mixed in children who are HEU. This small descriptive pilot study aimed to compare neurodevelopmental scores of children who are HIV+, HEU, and HUU in Kenya.Methods: This cross-sectional pilot study included children ages 18–36 months who were HIV+, HEU, or HUU. Neurodevelopment was assessed, along with sociodemographic, lab, and growth data. Statistical analysis included descriptive statistics, one-way ANOVA, chi-squared, and adjusted linear regression models.Results: One hundred seventy two were included (n = 24 HIV+; n = 74 HEU; n = 74 HUU). Mothers of children who were HEU experienced more depressive symptoms (p < 0.001). The only neurodevelopmental differences were found among groups was that children who were HIV+ had higher receptive language scores (p = 0.007). Lower height-for-age z-scores and being left home alone were associated with worse neurodevelopmental scores.Conclusions: Being stunted, left completely alone for at least an hour within the last week, and having higher sociodemographic status were associated with worse neurodevelopmental scores. The higher levels of depressive symptoms within mothers of children who are HEU warrants further investigation.

Implementation of UNICEF and WHO's care for child development package: Lessons from a global review and key informant interviews

“…Others made substantive modifications by providing more specific recommendations on how to engage in responsive play and communication activities and creating a structured curriculum to guide delivery agents in their interactions with caregivers. For example, seven studies explicitly reported making substantive modifications to the play and communication activities of the CCD package (( 24 ) [Indonesia]; ( 25 ) [Mozambique], ( 26 ) [Tanzania]; ( 27 ) [Malawi]; ( 28 ) [Kenya]; ( 29 ) [India and Pakistan]; ( 17 ) [Pakistan] 5 ). In Malawi, this consisted of modifying play and communication activities to focus on touch, hearing, and other senses for children with visual impairments ( 27 ).…”

“…These beneficiaries mostly came from low socioeconomic backgrounds. Nine studies specifically targeted vulnerable groups: children born prematurely or with low birth weight (( 40 ) [Dominican Republic]), children with visual impairments (( 27 ) [Malawi]), children with other physical and/or cognitive disabilities (( 40 ) [Dominican Republic]; ( 41 ) [El Salvador], ( 42 ) [Peru]; ( 31 ) [India]), children of HIV+ mothers (( 43 ) [Malawi]; ( 28 ) [Kenya]), children of incarcerated mothers (( 44 ) [Paraguay]), and children of HIV+ mothers experiencing antenatal depressive symptoms (( 39 ) [South Africa]).…”

Predicting neurodevelopmental risk in children born to mothers living with HIV in Kenya: protocol for a prospective cohort study (Tabiri Study)

“…15 Using data from our pilot study of children who were HEU (n=74) and HUU (n=74), a potential difference existed between these groups in the language domain. 41 While the difference was not statistically significant, these data were helpful for estimating our proposed sample size. Using the Bayley-3 language composite scores of this study, children who were HEU had a mean score of 73.4 (SD 13.7) and children who were HUU had a mean score of 76.3 (SD 12.7).…”

“…Using the Bayley-3 language composite scores of this study, children who were HEU had a mean score of 73.4 (SD 13.7) and children who were HUU had a mean score of 76.3 (SD 12.7). 41 Using an average SD of 13.2, the resulting effect size is 0.22 standardised difference between means (ie, Cohen's d) for continuous neurodevelopment outcomes. With a 0.22 effect size, an alpha of 0.05 and 80% power, the estimated sample size needed is 326 per group.…”

Who is championing programming to ensure children who are HIV-exposed yet uninfected thrive to their fullest potential?

“…Rodriguez et al [1] report on the use of the Bayley Infant Neurodevelopmental Screener (BINS) to identify infant outcomes in five domains: cognitive, receptive language, expressive language, fine motor, and gross motor in their manuscript entitled ‘Prevalence of neurodevelopmental delays in infants with perinatal HIV infection in comparison with HIV exposure in rural South Africa’ [1]. Many studies have reported on increased risk of delayed or poorer neurodevelopmental outcomes among children living with HIV, as well as those with fetal exposure to HIV, and increasingly maternal antiretroviral treatment, who remain HIV-uninfected [2–4]. In the highest burden HIV settings, health system constraints preclude the use of lengthy, in-depth assessments of children living with HIV and those HIV-exposed uninfected (HEU) to identify those in need of additional support to reach their fullest developmental potential.…”