title: HIV-associated neurodevelopmental delay: prevalence, predictors and persistence in relation to antiretroviral therapy initiation and viral suppression.
abstract: HIV infection in infancy may influence the developing brain, leading to adverse neurodevelopmental consequences.
  
  
  
  We aim to describe neurodevelopmental characteristics of a cohort of HIV-infected infants and young children prior to antiretroviral therapy (ART) initiation and after achieving viral suppression.
  
  
  
  As part of the Neverest 2 trial, 195 HIV-infected children under 2 years of age were assessed using the Ages and Stages Questionnaire (ASQ) prior to ART initiation and at subsequent age-appropriate time points after ART had been started. The ASQ is a simple screening questionnaire used to identify children at risk of neurodevelopmental delays. Questionnaires completed by the parent/caregiver assess neurodevelopmental functioning in five domains: communication, gross motor, fine motor, problem solving and personal-social.
  
  
  
  Median age pre-ART was 8.8 months (range 2.2-24.9) and 53.9% were male. Mean time to viral suppression was 9.4 months (range 5.9-14.5). Compared with pre-ART better outcomes were reported at time of viral suppression with a lower proportion of children failing the gross motor (31.5% vs. 13%, p = 0.0002), fine motor (21.3% vs. 10.2%, p = 0.017), problem solving (26.9% vs. 9.3%, p = 0.0003) and personal-social (19.6% vs. 7.4%, p = 0.019) domains. However, there was no change in the communication domain (14.8% vs. 12.0%, p = 0.6072).
  
  
  
  Although achieving viral suppression on ART resulted in significant improvements in markers of neurodevelopmental function of young HIV-infected children, potential neurodevelopmental delays still persisted in a large proportion. Further interventions are needed to limit potential disabilities and maximize developmental outcomes.
authors.affiliation: Empilweni Services and Research Unit (ESRU), Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. renate.strehlau@wits.ac.za.
authors.forename: R
authors.initials: R
authors.lastname: Strehlau
authors.affiliation: Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.|Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: L
authors.initials: L
authors.lastname: Kuhn
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.|ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Abrams
authors.affiliation: Empilweni Services and Research Unit (ESRU), Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: A
authors.initials: A
authors.lastname: Coovadia
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002675:Child, Preschool; D003142:Communication; D002658:Developmental Disabilities / Q000453:epidemiology / Q000523:psychology / Q000821:virology*; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008297:Male; D015995:Prevalence; D011340:Problem Solving; D011597:Psychomotor Performance; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D019562:Viral Load / Q000187:drug effects
chemical_list: D019380:Anti-HIV Agents
keywords: AIDS; child development; screening