Timing of perinatal human immunodeficiency virus type 1 infection and rate of neurodevelopment. The Women and Infant Transmission Study Group.
BACKGROUND
Identifying HIV-1-infected children who are at greatest risk for disease-related morbidities is critical for optimal therapeutic as well as preventive care. Several factors have been implicated in HIV-1 disease onset and severity, including maternal and infant host characteristics, viral phenotype and timing of HIV-1 infection. Early HIV-1 culture positivity, i.e. intrauterine infection, has been associated with poor immunologic, virologic and clinical outcomes in children of HIV-infected women. However, a direct effect of timing of infection on neurodevelopmental outcome in infancy has not yet been identified.


METHODS
Serial neurodevelopmental assessments were performed with 114 infants vertically infected with HIV-1 in a multicenter natural history, longitudinal study. Median mental and motor scores were compared at three time points. Longitudinal regression analyses were used to evaluate the neurodevelopmental functioning of children with early positive cultures and those with late positive cultures.


RESULTS
Early infected infants scored significantly lower than late infected infants by 24 months of age and beyond on both mental (P = 0.05) and motor (P = 0.03) measures. Early HIV-1 infection was associated with a decline in estimated motor scores of 1 standard score point per month compared with 0.28 point in the late infected group (P < 0.02). Estimated mental scores of the early infected group declined 0.72 point/ month, whereas the average decline of the late infected group was 0.30 point/month (P < 0.13).


CONCLUSIONS
Early HIV-1 infection increases a child's risk for poor neurodevelopmental functioning within the first 30 months of life.
Smith
R
R
University of Illinois at Chicago, 60612, USA. resmith@uic.edu
Malee
K
K
Charurat
M
M
Magder
L
L
Mellins
C
C
Macmillan
C
C
Hittleman
J
J
Lasky
T
T
Llorente
A
A
Moye
J
J
D002657:Child Development; D002675:Child, Preschool; D003072:Cognition Disorders / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000635:transmission; D015497:HIV-1 / Q000472:pathogenicity*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D019957:Motor Skills Disorders / Q000209:etiology*; D009420:Nervous System / Q000254:growth & development / Q000821:virology; D013997:Time Factors