title: The timing of mother-to-child transmission of human immunodeficiency virus infection and the neurodevelopment of children in Tanzania.
abstract: OBJECTIVE
  To determine the association between the timing of mother-to-child transmission of human immunodeficiency virus (HIV)-1 and neurodevelopment among children born to HIV-1 infected mothers in Tanzania.
  
  
  METHODS
  Bayley Scales of Infant Development (2nd edition) were administered at 6, 12 and 18 months to a subset of children (N = 327). Linear regression models and Cox proportional hazard models were separately fitted for the mental development index (MDI) and the psychomotor development index (PDI).
  
  
  RESULTS
  Children who tested HIV-1-positive at birth had significantly higher decreases per month in MDI and PDI than HIV-1-negative children; 1.1 [95% confidence interval (95% CI), 0.4, 1.8] for MDI and 1.4 (95% CI 0.0, 2.7] for PDI. Children who tested HIV-1-positive after birth had an additional 0.6 (95% CI 0.1, 1.1) point decrease in MDI per month and a 0.6 (95% CI 0.0, 1.1) higher decrease in PDI each month than HIV-1-negative children. Testing HIV-1-positive at birth was associated with a 14.9 (95% CI 5.0, 44.7) times higher rate of becoming developmentally delayed in mental function, while testing HIV-1-positive after birth was associated with a 3.2 (95% CI 1.6, 6.4) times higher rate than in uninfected children.
  
  
  CONCLUSIONS
  HIV-1 infected infants performed worse on tests of neurodevelopment and were significantly more likely to be identified as developmentally delayed in the first 18 months of life than HIV-1-negative children. The effect of HIV-1 infection on neurodevelopment scores and the risk of developmental delay may be highest among those who are already HIV-1 infected at birth.
authors.affiliation: Departments of Epidemiology, Harvard School of Public Health, Boston, MA, USA. mina@hsph.harvard.edu
authors.forename: Nuala
authors.initials: N
authors.lastname: McGrath
authors.forename: Wafaie W
authors.initials: WW
authors.lastname: Fawzi
authors.forename: David
authors.initials: D
authors.lastname: Bellinger
authors.forename: James
authors.initials: J
authors.lastname: Robins
authors.forename: Gernard I
authors.initials: GI
authors.lastname: Msamanga
authors.forename: Karim
authors.initials: K
authors.lastname: Manji
authors.forename: Edward
authors.initials: E
authors.lastname: Tronick
mesh_terms: D000328:Adult; D002657:Child Development; D002658:Developmental Disabilities / Q000150:complications / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000635:transmission*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008137:Longitudinal Studies; D008297:Male; D009048:Motor Skills; D009420:Nervous System / Q000254:growth & development*; D011247:Pregnancy; D013636:Tanzania / Q000453:epidemiology; D013997:Time Factors