Improved neurodevelopmental outcomes
Polly Clayden, HIV i-Base
The developing brain is a major target for HIV. It is not yet known whether timing of initiation of antiretroviral therapy will affect neurodevelopmental outcomes in infants.
A substudy of CHER compared neurodevelopmental outcomes of 115 infants in this study from Tygerberg Childrens Hospital with 84 control infants enrolled in a linked vaccine study, CIPRASA Project4. 
In this prospective study, the investigators looked at the neurodevelopmental profile, according to the Griffiths Mental Developmental Scales (GMDS), at 10 – 15 months of age in four groups of infants:
- HIV-unexposed, uninfected
- HIV-exposed, uninfected
- HIV-infected, HAART initiated before 12 weeks of age
- HIV infected, HAART deferred until eligibility criteria met.
The investigators were blinded to the infants groups and a translator was used for Xhosa-speaking participants.
Of 115 infants from CHER enrolled, 13 withdrew from the study and/or were not co-enrolled (10 early, 3 deferred), 8 died (all deferred) and 4 were excluded (3 early, 1 deferred).
The investigators found that infants initiated on early ART have significantly better locomotor and general scores on the Griffiths Mental Development Scales at a median age of 11 months compared with infants on deferred HAART. Although mean quotients were lower on the other subscales in the deferred group, the differences were not significant. The mean scores on all subscales in the unexposed, uninfected group and the early HAART group were similar. They noted these results were despite careful monitoring and ready access to ART in the latter (Table I).
Table I. Mean quotients of infants for deferred vs early HAART and HIV- exposed uninfected and unexposed infants
|Deferred ART||Early ART||HIV-exposed uninfected||HIV-unexposed||p-value early vs deferred|
|Median age in months (range)||11.0 (10.1-14.4)||11.0 (10.0-15.5)||11.4 (10.1-15.5)||11.5 (9.9-13.6)|
|Mean locomotor quotient (± 1 SD)||88.9 (±16.3)||97.6 (±12.5)||105.3 (±14.3)||101.6 (±3.7)||0.01|
|Mean general quotient (± 1 SD)||100.1 (±13.8)||106.3 (±10.6)||106.0 (±10.1)||106.9 (±11.7)||0.02|
This article first appeared in issue 36 of the Journal of HIV Medicine, the journal of the Southern African Clinicians Society.
Unless otherwise stated, all references are to the programme and abstracts of the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention, 19 – 22 July 2009, Cape Town.
9. Laughton B et al. Early antiretroviral therapy is associated with improved neurodevelopmental outcome in HIV infected infants: evidence from the CHER (Children with HIV Early Antiretroviral Therapy) trial. Abstract MOPEB080. http://www.ias2009.org/pag/Abstracts.aspx?AID=1629