Neurodevelopmental delay among HIV-infected preschool children receiving antiretroviral therapy and healthy preschool children in Soweto, South Africa

Abstract

Neurodevelopmental delay has been documented in up to 97.5% of HIV-infected children in Soweto who were not yet on antiretroviral treatment (ART). With growing numbers of children in South Africa being successfully treated with ART, the effects of ART on neurocognitive functioning in children require investigation. The objective of this study was to determine the extent of neurodevelopmental delay in stable HIV-infected preschool children (aged five to six years) receiving ART and compare it to an apparently healthy (unconfirmed HIV-status) group of preschool children. Thirty HIV-infected preschool children (virologically and immunologically stable on ART for more than one year) were conveniently sampled from 350 eligible children on ART at the Harriet Shezi Children's Clinic in Soweto, Johannesburg. The comparison group comprised 30 well-nourished preschool children attending the Lilian Ngoyi Primary Health Care Clinic in Soweto for routine immunizations. Each child was assessed using the Griffiths Mental Development Scales-Extended Revised Version (GMDS-ER), at a single point in time. The overall developmental z-scores on GMDS-ER were <−2 (indicating severe delay) in 27 (90%) children in the HIV-infected group compared to 23 (76%) in the comparison group (p = 0.166). Mental handicap (overall GQ < 70) was evident in 46.7% of children in the HIV-infected group compared to 10% in the comparison group (p = 0.002). There was a 7.88-fold increased likelihood of severe delay in the HIV infected group. The HIV-infected group and comparison group had significantly different (p = 0.001) mean overall GQ scores of 70 (95% CI: 66.0–74.0) and 78 (95% CI: 75.6–80.5), respectively, with lower mean scores in the HIV-infected group in all individual domains. Early initiation of ART in HIV-infected infants may improve cognitive functioning among this group; however, intervention strategies which optimize early cognitive development for all children in the area need to be urgently considered.

Keywords:

• HIV
• child
• neurodevelopment
• cognitive
• encephalopathy

Acknowledgements

SL conceived and designed the study, collected data, and drafted the manuscript. SS performed most of the statistical analysis and participated in the drafting of the manuscript. TM supervised the study, contributed to the design of the study and the drafting of the manuscript. All authors approved the final draft. The authors thank Professor Pieter Bekker for his invaluable assistance with the statistical analysis of data. They also thank Dr. Barbara Laughton and Professor Lorna Jacklin for their advice and support. No funding was required for this study. Tammy Meyers is a Fogarty Fellow sponsored by grant no. 5U2RTW007370 and 5U2RTW007373. This article has not been submitted elsewhere, or been previously published. Ethical clearance was received from the Human Research Ethics Committee of the University of the Witwatersrand. The copyright information has been read and understood.