Correlates of age at attainment of developmental milestones in HIV-infected infants receiving early antiretroviral therapy
Benki-Nugent, S.; Eshelman, C.; Wamalwa, D.; Langat, A.; Tapia, K.; Okinyi, H.M.; John-Stewart, G.
Pediatric Infectious Disease Journal 34(1): 55-61
2015
ISSN/ISBN: 1532-0987 PMID: 25144793 DOI: 10.1097/inf.0000000000000526Document Number: 641151
Infant HIV-1 infection is associated with impaired neurologic and motor development. Antiretroviral therapy (ART) has the potential to improve developmental outcomes but the relative contributions of pre-ART disease status, growth, treatment regimen and ART response during infancy are unknown. Kenyan ART-naive infants <5-months old initiated ART and had monthly assessment of age of full neck control, unsupported walking and monosyllabic speech during 24 months of follow-up. Pre-ART and post-ART correlates of age at milestone attainment were evaluated using t tests or multivariate linear regression. Among 99 infants, pre-ART correlates of later milestone attainment included: underweight and stunted (neck control, walking and speech, all P values <0.05), missed prevention of mother-to-child transmission (P = 0.04) (neck control), previous hospitalization, World Health Organization (WHO) Stage III/IV, low CD4 count, and wasting (speech and walking, all P values <0.05), and low maternal CD4 (speech, P = 0.04). Infants initiated ART at a median of 14 days following enrollment. Infants receiving nevirapinevs lopinavir/ritonavir-based ART attained later speech (18.1 vs. 15.5 months, P = 0.003) . The long-term consequences of these delays are unknown.