Neurodevelopmental trajectory of HIV-infected children accessing care in Kinshasa, Democratic Republic of Congo

OBJECTIVE:To assess the effect of HIV care (including highly active antiretroviral therapy if eligible) on neurodevelopment.

DESIGN: Prospective cohort study.

METHODS: Motor and mental development of 35 HIV-infected children (aged 18-71 months) was assessed at entry into care and after 6 and 12 months using age-appropriate tools. Developmental trajectory was compared with 35 HIV-uninfected, affected, and 90 control children using linear mixed-effects models. Effects of age (<or= or >29 months) and timing of entry into care (before or after highly active antiretroviral therapy eligibility) were explored in secondary analyses.

RESULTS: At baseline, HIV-infected children had the lowest, control children the highest, and HIV-uninfected affected children intermediate mean developmental scores. After 1 year of care, HIV-infected children achieved mean motor and cognitive scores that were similar to HIV uninfected, affected children although lower compared with control children. Overall, HIV-infected children experienced accelerated motor development but similar gains in cognitive development compared with control children. Exploratory analyses suggest that younger children and those presenting early may experience accelerated greater gains in development.

CONCLUSIONS: HIV-infected children accessing care experience improved motor development, and may, if care is initiated at a young age or an early stage of the disease, also experience gains in cognitive development.

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