title: Neurodevelopment in children born to HIV-infected mothers by infection and treatment status.
abstract: BACKGROUND
  We reviewed the impact of HIV, HIV exposure, and antiretroviral therapy/prophylaxis on neurodevelopmental outcomes of HIV-infected and HIV-exposed-uninfected infants and children.
  
  
  METHODS
  A literature search of Medline, Embase, PsychINFO, Web of Science, PubMed, and conference Web sites (1990-March 2011) using the search terms, infant, child, HIV, neurodevelopment, cognition, language, and antiretroviral therapy, identified 31 studies of HIV/antiretroviral exposure using standardized tools to evaluate infant/child development as the main outcome. Articles were included if results were reported in children <16 years of age who were exposed to HIV and antiretrovirals in fetal/early life, and excluded if children did not acquire HIV from their mothers or were not exposed to antiretrovirals in fetal/early life.
  
  
  RESULTS
  Infants who acquired HIV during fetal and early life tended to display poorer mean developmental scores than HIV-unexposed children. Mean motor and cognitive scores were consistently 1 to 2 SDs below the population mean. Mean scores improved if the infant received treatment before 12 weeks and/or a more complex antiretroviral regimen. Older HIV-infected children treated with highly active antiretroviral therapy demonstrated near normal global mean neurocognitive scores; subtle differences in language, memory, and behavior remained. HIV-exposed-uninfected children treated with antiretrovirals demonstrated subtle speech and language delay, although not universally.
  
  
  CONCLUSIONS
  In comparison with resource-rich settings, HIV-infected and HIV-exposed-uninfected infants/children in resource-poor settings demonstrated greater neurodevelopmental delay compared with HIV-unexposed infants. The effects on neurodevelopment in older HIV-infected children commenced on antiretroviral therapy from an early age and HIV-exposed-uninfected children particularly in resource-poor settings remain unclear.
authors.affiliation: Centre for International Health and Development, and eMRC Centre of Epidemiology for Child Health, University College London, Institute of Child Health, London, United Kingdom. kirstyledoare@gmail.com
authors.forename: Kirsty
authors.initials: K
authors.lastname: Le Doaré
authors.forename: Ruth
authors.initials: R
authors.lastname: Bland
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Newell
mesh_terms: D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000494:pharmacology / Q000627:therapeutic use; D002648:Child; D002657:Child Development / Q000187:drug effects; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000209:etiology*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000635:transmission; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical; D009422:Nervous System Diseases / Q000209:etiology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy
chemical_list: D044966:Anti-Retroviral Agents