1. In-utero exposure to antiretrovirals and neurodevelopment among HIV-exposed-uninfected children in Botswana
- Author
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Shahin Lockman, Modiegi Diseko, George R. Seage, Betsy Kammerer, Gbolahan Ajibola, Chipo Petlo, Joseph Makhema, Penny Holding, Paige L. Williams, Sumona Chaudhury, Vicki Tepper, Jean Leidner, Roger L. Shapiro, and Gloria Mayondi
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Immunology ,Gross motor skill ,Breastfeeding ,HIV Infections ,Nervous System ,Bayley Scales of Infant Development ,Article ,Young Adult ,03 medical and health sciences ,Child Development ,0302 clinical medicine ,Pregnancy ,030225 pediatrics ,medicine ,Humans ,Immunology and Allergy ,Prospective Studies ,030212 general & internal medicine ,Pregnancy Complications, Infectious ,Toddler ,Prospective cohort study ,Maternal-Fetal Exchange ,Botswana ,business.industry ,Infant, Newborn ,Infant ,Environmental Exposure ,medicine.disease ,Confidence interval ,Infectious Diseases ,Anti-Retroviral Agents ,Cohort ,Female ,business - Abstract
OBJECTIVE Conflicting data exist regarding the impact of in-utero exposure to maternal combination antiretrovirals. We compared neurodevelopmental outcomes between HIV-exposed-uninfected (HEU) children exposed in utero to three-drug combination antiretroviral therapy (ART) vs. zidovudine (ZDV) monotherapy. DESIGN Prospective study of child neurodevelopment, nested within two cohorts of HIV-infected mothers and their children in Botswana (one observational, one interventional). METHODS The Tshipidi and Mma Bana studies enrolled HIV-infected women during pregnancy and followed their HEU children for 24 months. Mothers took three-drug ART or ZDV during pregnancy. ART-exposed babies were mostly breastfed, and ZDV-exposed were formula-fed. Neurodevelopmental outcomes, measured at 24 months using Bayley Scales of Infant and Toddler Development Third Edition (Bayley-III) and Development Milestones Checklist (DMC), were compared in adjusted linear regression according to antiretroviral exposure. RESULTS Of 598 HEU children with valid neurodevelopment assessments, 382 were ART-exposed and 210 were ZDV-exposed. Adjusted mean Bayley-III scores were similar among ART-exposed vs. ZDV-exposed, with adjusted mean differences (95% confidence interval): Bayley-III Cognitive: -0.3 (-1.4, 0.9); Gross Motor: 0.8 (-0.1, 1.7); Fine Motor: 0.5 (-0.2, 1.3); Expressive Language: 0.7 (-0.3, 1.7); Receptive Language: 0.1 (-0.7, 0.8); and DMC Locomotor: 0.0 (-0.5, 0.6); Fine Motor: 0.3 (-0.3, 0.8); Language: -0.1 (-0.5, 0.4); Personal-Social: 0.2 (-0.7, 1.1). Similarly, when restricted to formula-fed children in one cohort (Tshipidi), there were no differences in adjusted mean scores. CONCLUSION Neurodevelopmental outcomes at 24 months of age were similar in ART-exposed vs. ZDV-exposed HEU children. Maternal ART with breastfeeding does not appear to have an adverse effect on neurodevelopment.
- Published
- 2018