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


ABSTRACT: OBJECTIVES:To assess neurodevelopment of breastfed HIV-exposed uninfected (HEU) and breastfed HIV-unexposed children in the context of universal maternal antiretroviral therapy (ART). DESIGN:Prospective study with antenatal enrolment and follow-up of breastfeeding HEU and HIV-unexposed mother-infant pairs through 12-18 months postpartum. SETTING:Peri-urban community, Cape Town, South Africa. PARTICIPANTS:HEU (n?=?215) and HIV-unexposed (n?=?306) children. MAIN OUTCOME MEASURES:Cognitive, motor and language development at median 13 (interquartile range 12-14) months of age: continuous and dichotomous Bayley Scales of Infant and Toddler Development Third Edition (delay defined as composite score <85). RESULTS:Incidence of preterm delivery (<37 weeks) was similar among HEU and HIV-unexposed children (11 vs. 9%, P?=?0.31; median gestation 39 weeks); 48% were boys. Median breastfeeding duration was shorter among HEU vs. HIV-unexposed children (6 vs. 10 months). All HIV-infected mothers initiated lifelong ART (tenofovir-emtricitabine-efavirenz) antenatally. HEU (vs. HIV-unexposed) children had higher odds of cognitive delay [odds ratio (OR) 2.28 (95% confidence interval (CI) 1.13-4.60)] and motor delay [OR 2.10 (95% CI 1.03-4.28)], but not language delay, in crude and adjusted analysis. Preterm delivery modified this relationship for motor development: compared with term HIV-unexposed children, term HEU children had similar odds of delay, preterm HIV-unexposed children had five-fold increased odds of delay (adjusted OR 4.73, 95% CI 1.32; 16.91) and preterm HEU children, 16-fold increased odds of delay (adjusted OR 16.35, 95% CI 5.19; 51.54). CONCLUSION: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.

SUBMITTER: le Roux SM 

PROVIDER: S-EPMC6341164 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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

le Roux Stanzi M SM   Donald Kirsten A KA   Brittain Kirsty K   Phillips Tamsin K TK   Zerbe Allison A   Nguyen Kelly K KK   Strandvik Andrea A   Kroon Max M   Abrams Elaine J EJ   Myer Landon L  

AIDS (London, England) 20180801 13


<h4>Objectives</h4>To assess neurodevelopment of breastfed HIV-exposed uninfected (HEU) and breastfed HIV-unexposed children in the context of universal maternal antiretroviral therapy (ART).<h4>Design</h4>Prospective study with antenatal enrolment and follow-up of breastfeeding HEU and HIV-unexposed mother-infant pairs through 12-18 months postpartum.<h4>Setting</h4>Peri-urban community, Cape Town, South Africa.<h4>Participants</h4>HEU (n = 215) and HIV-unexposed (n = 306) children.<h4>Main out  ...[more]

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