Neurodevelopment of breastfed HIV-exposed uninfected and HIV-unexposed children in South Africa.
AIDS
; 32(13): 1781-1791, 2018 08 24.
Article
en En
| MEDLINE
| ID: mdl-29794831
ABSTRACT
OBJECTIVES:
To assess neurodevelopment of breastfed HIV-exposed uninfected (HEU) and breastfed HIV-unexposed children in the context of universal maternal antiretroviral therapy (ART).DESIGN:
Prospective study with antenatal enrolment and follow-up of breastfeeding HEU and HIV-unexposed mother-infant pairs through 12-18 months postpartum.SETTING:
Peri-urban community, Cape Town, South Africa.PARTICIPANTS:
HEU (nâ=â215) and HIV-unexposed (nâ=â306) children. MAIN OUTCOMEMEASURES:
Cognitive, motor and language development at median 13 (interquartile range 12-14) months of age continuous and dichotomous Bayley Scales of Infant and Toddler Development Third Edition (delay defined as composite score <85).RESULTS:
Incidence of preterm delivery (<37 weeks) was similar among HEU and HIV-unexposed children (11 vs. 9%, Pâ=â0.31; median gestation 39 weeks); 48% were boys. Median breastfeeding duration was shorter among HEU vs. HIV-unexposed children (6 vs. 10 months). All HIV-infected mothers initiated lifelong ART (tenofovir-emtricitabine-efavirenz) antenatally. HEU (vs. HIV-unexposed) children had higher odds of cognitive delay [odds ratio (OR) 2.28 (95% confidence interval (CI) 1.13-4.60)] and motor delay [OR 2.10 (95% CI 1.03-4.28)], but not language delay, in crude and adjusted analysis. Preterm delivery modified this relationship for motor development compared with term HIV-unexposed children, term HEU children had similar odds of delay, preterm HIV-unexposed children had five-fold increased odds of delay (adjusted OR 4.73, 95% CI 1.32; 16.91) and preterm HEU children, 16-fold increased odds of delay (adjusted OR 16.35, 95% CI 5.19; 51.54).CONCLUSION:
Young HEU children may be at increased risk for cognitive and motor delay despite universal maternal ART and breastfeeding; those born preterm may be particularly vulnerable.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Lactancia Materna
/
Infecciones por VIH
/
Desarrollo Infantil
/
Exposición a Riesgos Ambientales
/
Trastornos del Neurodesarrollo
Tipo de estudio:
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Adult
/
Female
/
Humans
/
Infant
/
Male
/
Newborn
/
Pregnancy
País/Región como asunto:
Africa
Idioma:
En
Revista:
AIDS
Asunto de la revista:
SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS)
Año:
2018
Tipo del documento:
Article