Abstract
Introduction: Over 15 million children who were exposed to HIV perinatally but uninfected (HEU) are alive globally, and they are faced with multiple risk factors for poor neurodevelopment. While children who are HIV-infected (HIV+) appear to have worse neurodevelopmental scores compared to children unexposed and uninfected with HIV (HUU), the evidence is mixed in children who are HEU. This small descriptive pilot study aimed to compare neurodevelopmental scores of children who are HIV+, HEU, and HUU in Kenya.Methods: This cross-sectional pilot study included children ages 18–36 months who were HIV+, HEU, or HUU. Neurodevelopment was assessed, along with sociodemographic, lab, and growth data. Statistical analysis included descriptive statistics, one-way ANOVA, chi-squared, and adjusted linear regression models.Results: One hundred seventy two were included (n = 24 HIV+; n = 74 HEU; n = 74 HUU). Mothers of children who were HEU experienced more depressive symptoms (p < 0.001). The only neurodevelopmental differences were found among groups was that children who were HIV+ had higher receptive language scores (p = 0.007). Lower height-for-age z-scores and being left home alone were associated with worse neurodevelopmental scores.Conclusions: Being stunted, left completely alone for at least an hour within the last week, and having higher sociodemographic status were associated with worse neurodevelopmental scores. The higher levels of depressive symptoms within mothers of children who are HEU warrants further investigation.
Highlights
Over 15 million children who were exposed to HIV perinatally but uninfected (HEU) are alive globally, and they are faced with multiple risk factors for poor neurodevelopment
Children aged 18–36 months are the population of interest in this study for the following reasons: [1] The young age (≤3 years) promotes early referral to intervention services during a critical period of child neurodevelopment, when intervention is most cost- and time-effective; [2] With 18 months as the lower age limit, cognitive and language domains may be tested with greater rigor and persisting delays will be more perceptible, while still allowing adequate time for intervention during this critical period; [3] From a feasibility standpoint, 18– 36 months is the upper age limit of children born to mothers living with HIV routinely attending the maternal-child health (MCH) clinics in Kenya, due to the timing of their final HIV testing
As a general example of expectation differences between cultures, we previously found that Kenyan clinical providers were concerned when children were not walking independent by 12 months of age [50], whereas, the U.S Centers for Disease Control expects that most children will not walk independently until 18 months [51]
Summary
Over 15 million children who were exposed to HIV perinatally but uninfected (HEU) are alive globally, and they are faced with multiple risk factors for poor neurodevelopment. While children who are HIV-infected (HIV+) appear to have worse neurodevelopmental scores compared to children unexposed and uninfected with HIV (HUU), the evidence is mixed in children who are HEU. This small descriptive pilot study aimed to compare neurodevelopmental scores of children who are HIV+, HEU, and HUU in Kenya. In the domains of receptive and expressive language, have been reported in young children who are HEU and exposed to ART compared to HUU [3,4,5,6]. With the current inconclusive evidence, further investigation is required to delineate the neurodevelopmental impact of HIV exposure [1]
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