title: Early antiretroviral therapy improves neurodevelopmental outcomes in infants.
abstract: OBJECTIVE
  To evaluate the effect of early versus deferred antiretroviral therapy (ART) on the neurodevelopment of infants from Cape Town participating in the Children with HIV Early Antiretroviral Therapy (CHER) trial.
  
  
  METHODS
  HIV-infected infants were randomized to early (<3 months) or deferred ART. HIV-uninfected infants (HIV-exposed and HIV-unexposed) provide background data.
  
  
  METHODS
  Neurological examination and Griffiths Mental Development Scales (GMDS) were administered between 10-16 months of age by testers blind to HIV status and randomized allocation. Mean quotients were compared using paired Student's t-tests.
  
  
  RESULTS
  Sixty-four infants on early ART and 26 on deferred ART (of potential 77 and 38 respectively on CHER trial) were assessed at median age 11 months (range 10-16). On the GMDS, all scores were lower in the deferred arm and the General Griffiths and Locomotor Scores were significantly lower: mean (SD) =100.1 (13.8) vs. 106.3 (10.6) P=0.02; and 88.9 (16.3) vs. 97.7 (12.5), P<0.01, respectively. Children with HIV who received early ART performed as well as children without HIV except on the Locomotor subscale. Both infected and uninfected mean GMDS scores were within the average range.
  
  
  CONCLUSIONS
  Infants initiated on early ART have significantly better Locomotor and general scores on the GMDS at median age 11 months compared to infants on deferred ART, despite careful monitoring and ready access to ART in the latter.
authors.affiliation: Children's Infectious Diseases Clinical Research Unit, Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Children's Hospital, Cape Town, South Africa. BL2@sun.ac.za
authors.forename: Barbara
authors.initials: B
authors.lastname: Laughton
authors.forename: Morna
authors.initials: M
authors.lastname: Cornell
authors.forename: Debbie
authors.initials: D
authors.lastname: Grove
authors.forename: Martin
authors.initials: M
authors.lastname: Kidd
authors.forename: Priscilla E
authors.initials: PE
authors.lastname: Springer
authors.forename: Els
authors.initials: E
authors.lastname: Dobbels
authors.forename: Anita J
authors.initials: AJ
authors.lastname: van Rensburg
authors.forename: Avy
authors.initials: A
authors.lastname: Violari
authors.forename: Abdel G
authors.initials: AG
authors.lastname: Babiker
authors.forename: Shabir A
authors.initials: SA
authors.lastname: Madhi
authors.forename: Patrick
authors.initials: P
authors.lastname: Jean-Philippe
authors.forename: Diana M
authors.initials: DM
authors.lastname: Gibb
authors.forename: Mark F
authors.initials: MF
authors.lastname: Cotton
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000494:pharmacology; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D002658:Developmental Disabilities / Q000453:epidemiology / Q000517:prevention & control*; D004334:Drug Administration Schedule; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D007223:Infant; D008297:Male; D009483:Neuropsychological Tests; D011597:Psychomotor Performance / Q000187:drug effects*; D013019:South Africa / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents