A prospective study of neurodevelopment of uninfected children born to human immunodeficiency virus type 1 positive mothers
Grupo de Inmunovirología, Facultad de Medicina, Universidad de Antioquía, Medellín, Colombia. Revista de neurologia
(Impact Factor: 0.83).
The human immunodeficiency virus type 1 (HIV-1) has tropism for the immune and central nervous systems (CNS). Intrauterine exposure to HIV-1 induces immunological alterations, independent of infection that might affect the development of the CNS. Similarly, the intrauterine exposure to antiretrovirals might also affect the neurodevelopment.
To evaluate the neurodevelopment of babies born to HIV-1 positive mothers (exposed) and compare with babies born to HIV-1 negative mothers (unexposed).
We carried-out an observational prospective study of neurodevelopment of 23 exposed and 20 unexposed children using the infant development scale Bayley-II, and the Denver-II test, neurological examination and anthropometric measurements during the first two years of life.
None of the exposed babies acquired the infection. At one month of age the exposed babies exhibit normal but statistically lower values in the head circumference, compared to unexposed neonates. No differences were found in the psychomotor development index between both studied groups and exposed babies exhibited a lower mental development index but only at six months of age. The exposed babies exhibited a higher number of alterations during the neurological and Denver-II tests without reaching significant differences.
The results suggest that intrauterine exposure to HIV-1 and to antiretrovirals in uninfected children born to HIV-1 positive mothers does not induce alterations in the neurodevelopment, at least during the first two years of life.
Available from: Mario Archila
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ABSTRACT: Introduction: Type 1 human immunodeficiency virus (HIV-1) is a lymphotropic and neurotropic retrovirus. Thus, it causes immunological and neurological alterations particularly in children. In the neonatal period the maturational changes of the central nervous system occur rapidly, and their alteration can be reflected in processes such as the sleep-awake pattern.
Objective: To evaluate sleep organization, EEG and respiratory pattern in newborns to HIV-1 positive mothers.
Methods: 22 infants underwent polysomnography. Delta brushes number in REM and NREM sleep, duration of interburst interval and interhemispheric synchrony were used to calculate EEG maturation. Analysis of the sleep architecture was based on polysomnographic sleep percentage of REM, NREM and transitional sleep to total sleep time.
Results: The difference between electroencephalographically calculated and clinically calculated conceptional age was less than two weeks. Percentages of REM and NREM sleep ranged from 39-64 and 30-58 with a median of 52.5 and 36.5 respectively. Concordance was lower in newborns who had high transitional sleep percentages, compared to that in newborns who did not have high such characteristic (p<0.05).
Discussion: Despite intrauterine exposure to HIV-1 and to antiretroviral drugs we did not observe a significant effect on EEG maturation. The decreased concordance in newborns with high transitional sleep percentages would suggest an alteration in the maturation process, but this aspect itself is not sufficient to consider that intrauterine exposure to HIV-1 and antiretrovirals affect the entire sleep architecture.
Future studies should clarify whether the decreased concordance between behavior and NREM sleep is replicable.
Iatreia 07/2013; 26(3):269.
Available from: Michael S Silverman
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ABSTRACT: Objective:To determine whether there is a higher risk for cognitive or language delay among HIV-exposed uninfected (HEU) children exposed to cART (zidovudine/lamivudine/lopinavir/ritonavir) in utero and through 1 year of breast-feeding (World health Organization Option B+), compared with the control children born to HIV-uninfected mothers.Design:This is a double cohort study from Lusaka, Zambia.Methods:HEU (n=97) and control (n=103) children aged 15-36 months were assessed on their early nonverbal problem-solving and language skills using the standardized Capute Scales. A score of less than 85 on the Capute Full-Scale Developmental Quotient (FSDQ) was considered indicative of developmental delay and was the primary outcome of interest.Results:An FSDQ of less than 85 was found in eight (8.3%) of HEU participants and 15 (14.6%) of controls. In univariate logistic regressions, lower income [odds ratio (OR)=0.93, P=0.02], older infant age (OR=1.08, P=0.03), lower birth weight (OR=0.16, P<0.001), and less maternal education (OR=0.41, P=0.047) were associated with the probability of FSDQ less than 85, whereas Group (control/HEU) was not (OR=1.88, P=0.16). In the multivariable analysis, only lower birth weight (OR=0.15, P<0.001) remained associated with FSDQ less than 85.Conclusions:Our study did not support the presence of an adverse effect on cognitive and language development with prolonged antepartum and postpartum cART e/xposure. Larger studies and studies of older HEU children will be required to confirm these reassuring findings.
AIDS (London, England) 07/2014; 28 Suppl 3:S323-S330. DOI:10.1097/QAD.0000000000000357 · 5.55 Impact Factor
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ABSTRACT: Perinatal use of combination antiretroviral therapy dramatically reduces vertical (mother-to-child) transmission of HIV, but has led to a growing population of children with perinatal HIV-exposure but uninfected (HEU). HIV can cause neurological injury among children born with infection, but the neuroanatomical and developmental effectsin HEU children are poorly understood.
We used structural magnetic resonance imaging (MRI) with diffusion tensor imaging (DTI) to compare brain anatomy between 30 HEU and 33 age-matched HIV-unexposed and uninfected (HUU) children from Thailand. Maps of brain volume and microstructural anatomy were compared across groups; associations were tested between neuroimaging measures and concurrent neuropsychological test performance.
Mean (SD) age of children was 10.3 (2.8) years and 58% were male. All were enrolled in school and lived with family members.Intelligence quotient (IQ) did not differ between groups. Caretaker education levels did not differ,but income was higher for HUU (p<0.001). We did not detect group differences in brain volume or DTI metrics,after controlling for sociodemographic factors. The mean (95% confidence interval) fractional anisotropy (FA) in the corpus callosum was 0.375 (0.368-0.381) in HEU compared to 0.370 (0.364-0.375) in HUU. Higher FA and lower mean diffusivity were each associated with higher IQ scoresin analyses with both groups combined.
No differences in neuroanatomical or brain integrity measures were detectable in HEU children compared to age- and sex-matched controls (HUU children). Expected associations between brain integrity measures and IQ scores were identified suggesting sufficient power to detect subtle associations that were present.
The Pediatric Infectious Disease Journal 06/2015; 34(9). DOI:10.1097/INF.0000000000000774 · 2.72 Impact Factor
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