title: Neurodevelopmental benefits of antiretroviral therapy in Ugandan children aged 0-6 years with HIV.
abstract: BACKGROUND
  Insufficient data on neurodevelopmental benefits of antiretroviral therapy (ART) in children.
  
  
  METHODS
  Prospective study of 329 mothers and children aged 0-6 years to assess neurodevelopment. Results stratified by the maternal (M) and child (C) HIV status (MHIV⁻/CHIV⁻, MHIV⁺/CHIV⁻, and MHIV⁺/CHIV⁺). Gross Motor, Visual Reception, Fine Motor, Receptive, and Expressive Language scores were assessed by Mullen Scales of Early Learning. Global cognitive function was derived from an Early Learning Composite (ELC) score. Standardized weight and height for age z scores were constructed, and the lowest 15% cutoff defined disability. Generalized linear models were used to estimate prevalence rate ratios (PRR) adjusted for the child's age, weight, and height. In HIV-positive children, generalized linear models assessed the impact of ART initiation and duration on neurodevelopment.
  
  
  RESULTS
  Compared with MHIV⁻/CHIV⁻ children, HIV-positive children were more likely to have global deficits in all measures of neurodevelopment except gross motor skills, whereas in MHIV⁺/CHIV⁻ children, there was impairment in receptive language [adjusted PRR = 2.67; confidence interval (CI): 1·08 to 6.60] and the ELC (adjusted PRR = 2.94; CI: 1.11 to 7.82). Of the children born to HIV-positive mothers, HIV-positive children did worse than MHIV⁺/CHIV⁻ only in visual reception skills (adjusted PRR = 2.86; CI: 1.23 to 6.65). Of the 116 HIV-positive children, 44% had initiated ART. Compared with ART duration of <12 months, ART durations of 24-60 months were associated with decreased impairments in Fine Motor, Receptive Language, Expressive Language, and ELC scores.
  
  
  CONCLUSIONS
  Longer duration on ART is associated with reduction of some neurologic impairment and early diagnosis and treatment of HIV-positive children is a priority.
authors.affiliation: *Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; †Rakai Health Science Program, Entebbe, Uganda; ‡Michigan State University, Lansing, MI; and §School of Public Health, Makerere University, Kampala, Uganda.
authors.forename: Heena
authors.initials: H
authors.lastname: Brahmbhatt
authors.forename: Michael
authors.initials: M
authors.lastname: Boivin
authors.forename: Victor
authors.initials: V
authors.lastname: Ssempijja
authors.forename: Godfrey
authors.initials: G
authors.lastname: Kigozi
authors.forename: Joseph
authors.initials: J
authors.lastname: Kagaayi
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
mesh_terms: D000328:Adult; D002648:Child; D002657:Child Development / Q000502:physiology; D002675:Child, Preschool; D003071:Cognition / Q000502:physiology*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000503:physiopathology; D018023:HIV Seronegativity / Q000502:physiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009048:Motor Skills / Q000502:physiology*; D011446:Prospective Studies; D013060:Speech / Q000502:physiology*; D014454:Uganda; D014796:Visual Perception / Q000502:physiology*