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In utero and peripartum antiretroviral exposure as predictor of cognition in 6- to 10-year-old HIV-exposed Ugandan children - a prospective cohort study.
Ezeamama, A E; Zalwango, S K; Sikorskii, A; Tuke, R; Musoke, P M; Giordani, B; Boivin, M J.
Afiliação
  • Ezeamama AE; Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA.
  • Zalwango SK; Directorate of Public Health and Environment, Kampala Capital City Authority, Kampala, Uganda.
  • Sikorskii A; Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA.
  • Tuke R; Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA.
  • Musoke PM; Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
  • Giordani B; Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda.
  • Boivin MJ; Departments of Psychiatry, Neurology, and Psychology, University of Michigan, Ann Arbor, MI, USA.
HIV Med ; 22(7): 592-604, 2021 08.
Article em En | MEDLINE | ID: mdl-33860626
OBJECTIVES: To quantify association between in utero/peripartum antiretroviral (IPA) exposure and cognition, i.e. executive function (EF) and socioemotional adjustment (SEA), in school-aged Ugandan children who were perinatally HIV-infected (CPHIV, n = 100) and children who were HIV-exposed but uninfected (CHEU, n = 101). METHODS: Children were enrolled at age 6-10 years and followed for 12 months from March 2017 to December 2018. Caregiver-reported child EF and SEA competencies were assessed using validated questionnaires at baseline, 6 and 12 months. IPA type - combination antiretroviral therapy (cART), intrapartum single-dose nevirapine ± zidovudine (sdNVP ± ZDV), nevirapine + zidovudine + lamivudine (sdNVP + ZDV + 3TC) - or no IPA (reference) was verified via medical records. IPA-related standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs) in cognitive competencies were estimated from regression models with adjustment for caregiver sociodemographic and contextual factors. Models were fitted separately for CPHIV and CHEU. RESULTS: Among CPHIV children, cART (SMD = -0.82, 95% CI: -1.37 to -0.28) and sdNVP ± ZDV (SMD = -0.41, 95% CI: -0.81 to -0.00) vs. no IPA predicted lower executive dysfunction over 12 months. Intrapartum sdNVP + ZDV + 3TC vs. no IPA predicted executive dysfunction (SMD = 0.80, 95% CI: 0.30-1.31), SEA problems (SMD = 0.63-0.76, 95% CI: 0.00-1.24) and lower adaptive skills (SMD = -0.36, 95% CI: -0.75-0.02) over 12 months among CHEU. Further adjustment for contextual factors attenuated associations, although most remained of moderate clinical importance (|SMD| > 0.33). CONCLUSIONS: Among CPHIV children, cART and sdNVP ± ZDV IPA exposure predicted, on average, lower executive dysfunction 6-10 years later. However, peripartum sdNVP + ZDV + 3TC predicted executive and SEA dysfunction among CHEU 6-10 years later. These data underscore the need for more research into long-term effects of in utero ART to inform development of appropriate interventions so as to mitigate cognitive sequelae.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações Infecciosas na Gravidez / Infecções por HIV / Fármacos Anti-HIV Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Child / Female / Humans / Pregnancy País/Região como assunto: Africa Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações Infecciosas na Gravidez / Infecções por HIV / Fármacos Anti-HIV Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Child / Female / Humans / Pregnancy País/Região como assunto: Africa Idioma: En Ano de publicação: 2021 Tipo de documento: Article