title: Comparison of developmental milestone attainment in early treated HIV-infected infants versus HIV-unexposed infants: a prospective cohort study.
abstract: Infant HIV infection is associated with delayed milestone attainment. The extent to which effective antiretroviral therapy (ART) prevents these delays is not well defined.
  
  
  
  Ages at attainment of milestones were compared between HIV-infected (initiated ART by age <5 months), and HIV-unexposed uninfected (HUU) infants. Kaplan Meier analyses were used to estimate and compare (log-rank tests) ages at milestones between groups. Adjusted analyses were performed using Cox proportional hazards models.
  
  
  
  Seventy-three HIV-infected on ART (median enrollment age 3.7 months) and 92 HUU infants (median enrollment age 1.6 months) were followed prospectively. HIV-infected infants on ART had delays in developmental milestone attainment compared to HUU: median age at attainment of sitting with support, sitting unsupported, walking with support, walking unsupported, monosyllabic speech and throwing toys were each delayed (all p-values <0.0005). Compared with HUU, the subset of HIV-infected infants with both virologic suppression and immune recovery at 6 months had delays for speech (delay: 2.0 months; P = 0.0002) and trend to later walking unsupported. Among HIV-infected infants with poor 6-month post-ART responses (lacking viral suppression and immune recovery) there were greater delays versus HUU for: walking unsupported (delay: 4.0 months; P = 0.0001) and speech (delay: 5.0 months; P < 0.0001).
  
  
  
  HIV infected infants with viral suppression on ART had better recovery of developmental milestones than those without suppression, however, deficits persisted compared to uninfected infants. Earlier ART may be required for optimized cognitive outcomes in perinatally HIV-infected infants.
  
  
  
  NCT00428116 ; January 22, 2007.
authors.affiliation: Department of Global Health, University of Washington, Box 359909, 325 9th Ave., Seattle, WA, 98104, USA. benki@u.washington.edu.
authors.forename: Sarah
authors.identifier: 0000-0002-3034-8257
authors.initials: S
authors.lastname: Benki-Nugent
authors.affiliation: Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
authors.forename: Dalton
authors.initials: D
authors.lastname: Wamalwa
authors.affiliation: Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
authors.forename: Agnes
authors.initials: A
authors.lastname: Langat
authors.affiliation: Department of Global Health, University of Washington, Box 359909, 325 9th Ave., Seattle, WA, 98104, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Tapia
authors.affiliation: Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
authors.forename: Judith
authors.initials: J
authors.lastname: Adhiambo
authors.affiliation: Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
authors.forename: Daisy
authors.initials: D
authors.lastname: Chebet
authors.affiliation: Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
authors.forename: Helen Moraa
authors.initials: HM
authors.lastname: Okinyi
authors.affiliation: Department of Global Health, University of Washington, Box 359909, 325 9th Ave., Seattle, WA, 98104, USA.
authors.forename: Grace
authors.initials: G
authors.lastname: John-Stewart
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D002658:Developmental Disabilities / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D015497:HIV-1; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents
keywords: Antiretroviral therapy; Early antiretroviral therapy; HIV; Infant; Neurodevelopment; Sub-Saharan Africa