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Pediatr Infect Dis J. 2019 Apr 10. doi: 10.1097/INF.0000000000002332. [Epub ahead of print]

In Utero Efavirenz Exposure and Neurodevelopmental Outcomes in HIV-exposed Uninfected Children in Botswana.

Author information

1
From the Center for Neuropsychology, Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts.
2
Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
3
Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
4
Goodtables Consulting, Norman, Oklahoma.
5
Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
6
Educate Africa, Mombasa, Kenya.
7
Massachusetts General Hospital, Boston, Massachusetts.
8
Ministry of Health and Wellness, Gaborone, Botswana.
9
Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
10
Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts.

Abstract

BACKGROUND:

Minimal data exist related to neurodevelopment after in utero exposure to Efavirenz (EFV). We sought to compare neurodevelopmental outcomes in HIV-exposed/uninfected (HEU) children with in utero exposure to EFV-based triple antiretroviral treatment (ART) versus non-EFV-based ART, and to examine whether timing of initial EFV exposure is associated with neurodevelopment deficits.

METHODS:

Women living with HIV who had received EFV-based ART during pregnancy and whose HEU newborn participated in a prior study were reconsented for their HEU toddler to undergo neurodevelopmental testing at 24 months old. We administered the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III), Developmental Milestones Checklist (DMC) and Profile of Social Emotional Development (PSED). We compared outcomes to previously-collected data from a cohort of 24-month-old HEU children with in utero exposure to non-EFV-based ART. Adjusted general linear models were used to compare mean outcomes.

RESULTS:

Our analysis included 493 HEU children (126 EFV-exposed, 367 EFV-unexposed). Adjusted mean scores for the EFV-exposed group were worse than the EFV-unexposed group on BSID-III Receptive Language (adjusted means = 21.5 vs. 22.5, P = 0.05), DMC Locomotor (30.7 vs. 32.0, P < 0.01) and Fine Motor scales (17.8 vs. 19.2, P < 0.01); and PSED (11.7 vs. 9.9, P = 0.02); but better on the DMC Language scale (17.6 vs. 16.5, P = 0.01). Earlier (vs. later) EFV exposure was associated with worse scores on the BSID-III Receptive Language scale (20.7 vs. 22.2, P = 0.02).

CONCLUSIONS:

HEU children exposed in utero to EFV-based ART may be at higher risk for neurodevelopmental and social-emotional deficits than HEU children exposed to non-EFV-based ART.

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