Laurén A Gómez1, Claudia S Crowell2, Irene Njuguna3, Lisa M Cranmer4, Dalton Wamalwa3, Daisy Chebet3, Vincent Otieno3, Elizabeth Maleche-Obimbo3, Melissa Gladstone5, Grace John-Stewart1, Sarah Benki-Nugent1. 1. From the Department of Global Health, University of Washington, Seattle, Washington. 2. Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington. 3. Department of Paediatrics & Child Health, University of Nairobi, Nairobi, Kenya. 4. Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia. 5. Department of Women's and Children's Health, University of Liverpool, Liverpool, United Kingdom.
Abstract
BACKGROUND: Late human immunodeficiency virus (HIV) diagnosis after severe co-morbidity remains common in resource-limited settings. Neurodevelopmental recovery during antiretroviral therapy (ART) for late-diagnosed children is understudied. We determined 6-month neurodevelopmental trajectories in HIV-infected children initiating ART during hospitalization. METHODS:HIV-infected children initiated ART after HIV diagnosis during hospitalization in Kenya. The Malawi Developmental Assessment Tool was administered after clinical stabilization within 1 month and at 6 months post-ART initiation. Baseline versus 6-month Z scores for each developmental domain were compared; cofactors for change in Z scores were evaluated using linear regression. RESULTS: Among 74 children, median age was 1.7 years (interquartile range, 0.8-2.4) andmedian Z scores for gross motor, fine motor, social and language domains were -1.34, -1.04, -0.53 and -0.95, respectively. At baseline, children with higher plasma viremia had lower social Z scores (P = 0.008). Better nourished (weight-for-age Z score [WAZ] ≥-2) children had higher Z scores in all developmental domains (all P values ≤0.05). After 6 months on ART (n = 58), gross and fine motor Z scores improved significantly (mean change 0.39; P = 0.007 and 0.43; P = 0.001, respectively), but social and language did not. Children with better immune and growth response to ART had higher gains in gross motor (0.05 per unit-gain CD4%; P = 0.04; 0.34 per unit-gain WAZ; P = 0.006 and 0.44 per unit-gain height-for-age Z score; P = 0.005), social (0.37 per unit-gain WAZ; P = 0.002) and language (0.25 per unit-gain height-for-age Z score; P = 0.01). CONCLUSIONS: Children had significant neurodevelopmental gains during 6 months of ART, and children with better growth and immune recovery had greater improvement. Prompt commencement of ART may improve neurodevelopment in addition to immunity and growth.
RCT Entities:
BACKGROUND: Late human immunodeficiency virus (HIV) diagnosis after severe co-morbidity remains common in resource-limited settings. Neurodevelopmental recovery during antiretroviral therapy (ART) for late-diagnosed children is understudied. We determined 6-month neurodevelopmental trajectories in HIV-infectedchildren initiating ART during hospitalization. METHODS:HIV-infectedchildren initiated ART after HIV diagnosis during hospitalization in Kenya. The Malawi Developmental Assessment Tool was administered after clinical stabilization within 1 month and at 6 months post-ART initiation. Baseline versus 6-month Z scores for each developmental domain were compared; cofactors for change in Z scores were evaluated using linear regression. RESULTS: Among 74 children, median age was 1.7 years (interquartile range, 0.8-2.4) and median Z scores for gross motor, fine motor, social and language domains were -1.34, -1.04, -0.53 and -0.95, respectively. At baseline, children with higher plasma viremia had lower social Z scores (P = 0.008). Better nourished (weight-for-age Z score [WAZ] ≥-2) children had higher Z scores in all developmental domains (all P values ≤0.05). After 6 months on ART (n = 58), gross and fine motor Z scores improved significantly (mean change 0.39; P = 0.007 and 0.43; P = 0.001, respectively), but social and language did not. Children with better immune and growth response to ART had higher gains in gross motor (0.05 per unit-gain CD4%; P = 0.04; 0.34 per unit-gain WAZ; P = 0.006 and 0.44 per unit-gain height-for-age Z score; P = 0.005), social (0.37 per unit-gain WAZ; P = 0.002) and language (0.25 per unit-gain height-for-age Z score; P = 0.01). CONCLUSIONS:Children had significant neurodevelopmental gains during 6 months of ART, and children with better growth and immune recovery had greater improvement. Prompt commencement of ART may improve neurodevelopment in addition to immunity and growth.
Authors: Theodore D Ruel; Michael J Boivin; Hannah E Boal; Paul Bangirana; Edwin Charlebois; Diane V Havlir; Philip J Rosenthal; Grant Dorsey; Jane Achan; Carolyne Akello; Moses R Kamya; Joseph K Wong Journal: Clin Infect Dis Date: 2012-02-04 Impact factor: 9.079
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Irene N Njuguna; Anjuli D Wagner; Lisa M Cranmer; Vincent O Otieno; Judith A Onyango; Daisy J Chebet; Helen M Okinyi; Sarah Benki-Nugent; Elizabeth Maleche-Obimbo; Jennifer A Slyker; Grace C John-Stewart; Dalton C Wamalwa Journal: AIDS Patient Care STDS Date: 2016-03 Impact factor: 5.078
Authors: Dalton C Wamalwa; Elizabeth M Obimbo; Carey Farquhar; Barbra A Richardson; Dorothy A Mbori-Ngacha; Irene Inwani; Sara Benki-Nugent; Grace John-Stewart Journal: BMC Pediatr Date: 2010-05-18 Impact factor: 2.125
Authors: Avy Violari; Mark F Cotton; Diana M Gibb; Abdel G Babiker; Jan Steyn; Shabir A Madhi; Patrick Jean-Philippe; James A McIntyre Journal: N Engl J Med Date: 2008-11-20 Impact factor: 91.245
Authors: Thomas Struyf; Queen Dube; Elizabeth A Cromwell; Anna D Sheahan; Robert S Heyderman; Annelies Van Rie Journal: Eur J Paediatr Neurol Date: 2019-11-21 Impact factor: 3.140
Authors: Melissa J Gladstone; Jaya Chandna; Gwendoline Kandawasvika; Robert Ntozini; Florence D Majo; Naume V Tavengwa; Mduduzi N N Mbuya; Goldberg T Mangwadu; Ancikaria Chigumira; Cynthia M Chasokela; Lawrence H Moulton; Rebecca J Stoltzfus; Jean H Humphrey; Andrew J Prendergast Journal: PLoS Med Date: 2019-03-21 Impact factor: 11.069