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Pediatr Infect Dis J. 2018 Sep 18. doi: 10.1097/INF.0000000000002193. [Epub ahead of print]

HIV Viremia During Pregnancy and Neurodevelopment of HIV-Exposed Uninfected Children in the Context of Universal Antiretroviral Therapy and Breastfeeding: A Prospective Study.

Author information

1
Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, South Africa.
2
Department of Paediatrics & Child Health, University of Cape Town, South Africa.
3
Division of Developmental Paediatrics, Red Cross War Memorial Children's Hospital, Cape Town South Africa.
4
Neonatal service, Mowbray Maternity Hospital, Cape Town South Africa.
5
Centre for Infectious Disease Epidemiology and Research (CIDER), School of Public Health & Family Medicine, University of Cape Town, South Africa.
6
ICAP at Columbia, Mailman School of Public Health, Columbia University. New York, NY.
7
College of Physicians & Surgeons, Columbia University, New York, NY.

Abstract

BACKGROUND:

Elevated HIV viral load (HIV-VL) in pregnancy has been linked to increased risk of mortality, immunological abnormalities, infectious morbidity and restricted growth among HIV-exposed uninfected (HEU) children, but little is known about effects on child development.

METHODS:

HIV-infected women initiating lifelong ART (tenofovir+emtricitabine+efavirenz) antenatally were followed from first antenatal visit through delivery and with their breastfed infants postpartum. Cognitive, motor and expressive language development (Bayley Scales of Infant and Toddler Development, BSID-III; delay defined as score <85) were assessed on a subset of HEU infants. HIV-VL was measured at ART initiation, in third trimester and around delivery. Cumulative viraemia in pregnancy was expressed as log10 VL copies x year/mL (viraemia copy-years, VCY). Relationships between VCY and development were examined after adjusting for socio-economic, behavioural and psychosocial confounders.

RESULTS:

Women (median pre-ART log10 VL 4.1, CD4 349 cells/mm) commonly reported adverse social circumstances (44% informal housing, 63% unemployed, 29% risky drinking). Among 214 infants (median age 13 months; 53% male; 13% born <37 weeks' gestation), viraemia predicted lower motor and expressive language, but not cognitive, scores in crude and adjusted analysis [per log10 VCY increase, aβ (95%CI): motor, -2.94 (-5.77; -0.11); language, -3.71 (-6.73; -0.69) and cognitive-2.19 (-5.02; 0.65)]. Increasing VCY also predicted higher relative odds of motor delay [adjusted odds ratio, aOR 3.32 (95% CI 1.36; 8.14)] and expressive language delay [aOR 2.79 (95% CI 1.57; 4.94), but not cognitive delay [aOR 1.68 (0.84; 3.34)].

CONCLUSION:

Cumulative maternal HIV viraemia in pregnancy may have adverse implications for HEU child development.

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