Neurodevelopmental and behavioural outcomes of HIV-exposed uninfected and HIV-unexposed children at 2–3 years of age in Cape Town, South Africa

ABSTRACT

Successful vertical HIV transmission prevention programmes (VTP) have resulted in an expanding population of HIV-exposed uninfected (HEU) infants whose growth, health and neurodevelopmental outcomes could have consequences for future resource allocation. We compared neurodevelopmental and behavioural outcomes in a prospective cohort of 2–3 year old HEU and HIV-unexposed uninfected (HU) children.

Women living with and without HIV and their infants were enrolled within three days of birth from a low-risk midwife obstetric unit in Cape Town, South Africa during 2012 and 2013, under WHO Option A VTP guidelines. HIV-uninfected children aged 30–42 months were assessed using the Bayley scales of Infant Development-Third edition (BSID) and Strengths and Difficulties questionnaire (SDQ).

Thirty-two HEU and 27 HU children (mean birth weight 3048g vs 3096g) were assessed. HEU children performed as well as HU children on BSID cognitive, language and motor domains. Mean scores fell within the low average range. Mothers of HEU children reported fewer conduct problems but stunting was associated with increased total difficulties on the SDQ.

HEU and HU children’s performance on the BSID was similar. In this low-risk cohort, HIV exposure did not confer additional risk. Stunting was associated with increased behavioural problems irrespective of HIV exposure.

KEYWORDS:

• neurodevelopment
• behaviour
• HIV-exposed uninfected pre-school child

Acknowledgements

We thank the mothers, fathers and infants who generously donated their time to the MIHS. We thank SRN Ronel Barnard for her assistance with the assessments and data entry, and SRN Marchalaine Hendricks, Mr Aviwe Cweya, Staff Nurse S. Sylvester and Mr Carlos Moffat for their practical and logistical contributions. We acknowledge the study assistance provided by the staff at FAMCRU, Paediatrics and Child Health, Tygerberg Academic Hospital, Stellenbosch University and the Vaccine Evaluation Center, BC Children’s Hospital, University of British Columbia, Vancouver, Canada.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

P. E. Springer http://orcid.org/0000-0001-8882-5688

A. L. Slogrove http://orcid.org/0000-0002-8046-9268

M. Kidd http://orcid.org/0000-0002-4887-7296

E. Kalk http://orcid.org/0000-0001-7706-6866

J. A. Bettinger http://orcid.org/0000-0002-2118-4174

M. F. Cotton http://orcid.org/0000-0003-2559-6034

M. Zunza http://orcid.org/0000-0002-3270-8439

M. Kruger http://orcid.org/0000-0002-6838-0180

Additional information

Funding

This work was supported by HOPE Cape Town Trust (PBO (SA) No93/00/24/843-053-417NPO(SA) 2013-2016, South African Medical Research Council, the Harry Crossley Foundation, South Africa, National Institute of Health Major Thematic Grant from the Peter Wall Institute for Advanced Studies, University of British Columbia [grant number F0906208] and the Canadian Institutes of Health Research Canada-Hope Programme [grant number CH1-106949] Dr Slogrove receives salary support from the Fogarty International centre of the National Institute of Health under award number 1K43TW010683 and the CIPHER Grantee Programme of the International AIDS Society (2017/518-SLO). Dr Bettinger is a Michael Smith Foundation for Health Research Scholar. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.