Children born with HIV on treatment experience next-to-no developmental set-backs at the age of 5

24 May 2018

New data on the impact of different treatment strategies on the neuro-development of young children living with HIV has been released, showing normal development in all areas apart from visual perception.

5 year old xhosa kids

Children born with HIV accessing treatment, have no significant difference in their movement skills, social interaction, language skills or practical reasoning at age five compared to HIV-negative children, according to new research. However, some visual impairments were detected in the groups.

The study followed around 200 newborns aged 12-weeks-and-under from Cape Town, South Africa, between 2006 and 2013. Of the infants included in the study, 119 were HIV-positive, while 84 were HIV negative.

When the study began, the HIV positive infant group had a CD4 percentage within the normal range and were not displaying any symptoms of HIV. Of the HIV negative control group, half had been exposed to HIV through childbirth or breastfeeding but had not contracted the virus.

The study aimed to gain a better insight into how treatment can protect children from neurological disorders associated with early HIV infection. Previous research has shown that HIV can enter the central nervous system early in the course of infection and cause several neurological disorders if not treated early enough, including HIV encephalopathy, which affects cognitive, motor, and behavioural functions. This can have lasting impact in infants and children who are in the process of acquiring these skills as they develop.

Over a five-year period, researchers analysed participants’ movement skills, personal and social interaction, hearing and language skills, eye-and-hand coordination and visual perception. When infants reached 24-months, their practical reasoning skills were also assessed.

At the end of the study researchers found the 5-year-olds living with HIV were at a similar development level as their HIV-negative peers in all skill-categories except visual perception, where HIV-positive children scored significantly lower. This was irrespective of the treatment group the children belonged to.

Researchers hypothesized that early sight deficits may be responsible for cognitive differences found in older children. Further investigation is required to understand more about this relationship, and whether early interventions addressing visual impairment could have a long-term impact on development and educational outcomes in HIV-positive children.

Although the HIV-positive children had displayed less developed movement skills at 11 and 20 months, this discrepancy had righted itself by 42 months with both groups at a similar level.

The study also assessed the effects of treatment interruption on neurological development in children. HIV-positive infants were split into three groups. One group was started on antiretroviral treatment (ART) immediately to achieve viral suppression then had treatment interrupted at 40 weeks. The second group started ART immediately but interrupted treatment at 96 weeks, while the third group deferred treatment. Infants from all three groups were then started on continuous treatment as soon as their CD4 percentage fell below the normal range or if they displayed symptoms suggesting HIV had progressed to a more severe clinical stage (stage B or C).

Researchers found treatment interruption appeared safe in children who had been virally suppressed early, compared to the group that had started treatment later. This is particularly reassuring for contexts where a lack of supplies means ART interruption may be unavoidable – suggesting that treatment offered early on can offer protection during later interruptions.

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Written by Hester Phillips