1
|
Fairlie L, Chernoff M, Cotton MF, Bwakura-Dangarembizi M, Violari A, Familiar-Lopez I, Barlow-Mosha L, Kamthunzi P, McCarthy K, Jean-Philippe P, Laughton B, Palumbo PE, Boivin MJ. Antiretroviral choice and severe disease predict poorer neuropsychological outcomes in HIV+ children from Africa. Front Pediatr 2022; 10:899002. [PMID: 35989995 PMCID: PMC9382189 DOI: 10.3389/fped.2022.899002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/13/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The International Maternal Pediatric Adolescent AIDS Clinical Trials Network (IMPAACT) P1104s study evaluated neuropsychological outcomes over 96 weeks in children living with HIV (CLHIV) aged 5-11 years at 6 Sub-Saharan African sites to explore associations between HIV-illness related biomarkers and neuropsychological outcomes. METHODS Children living with HIV had participated in IMPAACT P1060, which compared efficacy of nevirapine versus lopinavir/ritonavir in children initiating ART at <3 years of age. At age 5-11, neuropsychological evaluations of KABC cognitive ability, TOVA attention-impulsivity and BOT-2 motor domains were assessed and repeated after 48 and 96 weeks. Clinical, antiretroviral therapy (ART) and laboratory (immunological and virological) parameters were used to predict neuropsychological outcomes using linear mixed-effects multivariable regression models, controlling for child and caregiver characteristics. RESULTS 246 CLHIV (45% male, mean age at initial neuropsychological evaluation 7.1 yrs [SD 1.2]) began ART at a median age 14.9 months (IQR 8.2, 25.2). Nadir CD4 percentage was 14.7% (IQR 11.0, 19.5); the median peak viral load (VL) was 750 000 copies/ml (IQR 366 000, 750 000) and 63% had ≥WHO stage 3 clinical disease; 164 (67%) were on lopinavir/ritonavir, 71 (29%) were on nevirapine and 7 (3%) were on efavirenz. Other antiretrovirals were similar. Nevirapine at P1104s study start or later was associated with poorer neuropsychological scores across all domains except Global Executive Composite, even when controlling for nadir CD4 percent and time-varying HIV VL. Other predictors of poorer scores in KABC domains included low birth weight, WHO stage 4 disease and serious illness history and elevated VL was associated with worse BOT-2 scores. CONCLUSION Children receiving nevirapine had poorer neuropsychological scores than those on lopinavir/ritonavir. Antiretroviral choice might adversely impact neuropsychological performance. In addition, low birth weight and markers of severe HIV disease: advanced WHO clinical HIV disease, history of serious illness and an elevated VL, were associated with lower neuropsychological scores.
Collapse
Affiliation(s)
- Lee Fairlie
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Miriam Chernoff
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Mark F Cotton
- Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Tygerberg, South Africa
| | - Mutsa Bwakura-Dangarembizi
- Harare Family Care CRS, College of Health Sciences Clinical Trials Unit, University of Zimbabwe, Harare, Zimbabwe
| | - Avy Violari
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Itziar Familiar-Lopez
- Department of Psychiatry, Michigan State University, East Lansing, MI, United States
| | - Linda Barlow-Mosha
- Makerere University-Johns Hopkins University Research Collaboration, MU-JHU Care Ltd., CRS, Kampala, Uganda
| | - Portia Kamthunzi
- University of North Carolina Project-Lilongwe, Malawi CRS, Lilongwe, Malawi
| | | | - Patrick Jean-Philippe
- National Institute of Allergy and Infectious Diseases, National Institute of Health, Rockville, MD, United States
| | - Barbara Laughton
- Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Tygerberg, South Africa
| | - Paul E Palumbo
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Michael J Boivin
- Department of Psychiatry, Michigan State University, East Lansing, MI, United States.,Department of Neurology and Ophthalmology, Michigan State University, East Lansing, MI, United States.,Department of Psychiatry, The University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
2
|
van der Merwe TA, van Zyl GU, Lombard CJ, Theron GB. Intrapartum human immunodeficiency virus transmission rate in a central hospital in the Western Cape province after universal antiretroviral therapy roll-out. S Afr J Infect Dis 2021; 35:192. [PMID: 34485480 PMCID: PMC8378200 DOI: 10.4102/sajid.v35i1.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 10/05/2020] [Indexed: 12/05/2022] Open
Abstract
The national human immunodeficiency virus (HIV) mother-to-child transmission rate at 6–10 weeks post-partum was 0.9% in 2016. There is a paucity of data about the intrapartum transmission rate after lifelong antiretroviral therapy was implemented in 2015. We assessed all pregnant women living with HIV who delivered at Tygerberg Hospital in 2017. Positive polymerase chain reactions (PCRs) at birth indicated an in utero transmission rate of 0.8%. One infant with a negative PCR at birth tested positive at 6–10 weeks. The intrapartum transmission rate was low (0.08%). About 25% of infants were lost to follow-up after birth.
Collapse
Affiliation(s)
- Tian A van der Merwe
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gert U van Zyl
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,National Health Laboratory Service, Tygerberg Virology, South Africa
| | - Carl J Lombard
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Gerhard B Theron
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
3
|
Abstract
Advances in perinatal HIV management have averted a significant number of infections in neonates and have made the possibility of elimination of mother-to-child transmission a reality; however, significant gaps in implementation of early testing programs as well as the expansion of therapeutic strategies to neonates are hindering prevention efforts and access to safer, more effective and easier to administer treatment. This article provides insights on the current state of perinatal HIV, recent advances, and future needs.
Collapse
Affiliation(s)
- Andres F Camacho-Gonzalez
- Division of Pediatric Infectious Diseases, Children's Healthcare of Atlanta, Emory University School of Medicine, 2015 Uppergate Drive, Suite 500, Atlanta, GA 30322, USA.
| | - Paul Palumbo
- Section of Infectious Diseases and International Health, Geisel School of Medicine at Dartmouth, 1 Medical Center Drive, Lebanon, NH 03756, USA
| |
Collapse
|
4
|
Strehlau R, Burke M, van Aswegen T, Kuhn L, Potterton J. Neurodevelopment in early treated HIV-infected infants participating in a developmental stimulation programme compared with controls. Child Care Health Dev 2021; 47:154-162. [PMID: 33150965 PMCID: PMC7854479 DOI: 10.1111/cch.12828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/30/2020] [Accepted: 11/03/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Neurodevelopmental stimulation programmes can improve developmental outcomes. Antiretroviral therapy (ART) started soon after birth potentially limits the invasion of HIV into the central nervous system. A combination of developmental stimulation and early ART initiation may reduce developmental delays in children with perinatally acquired HIV infection. METHODS At a single site in Johannesburg, South Africa, we enrolled 36 HIV-infected neonates on ART into an intervention group (IG) participating in a yearlong home-based, neurodevelopmental stimulation programme. Bayley Scales of Infant and Toddler Development-3rd Edition (BSID-III) assessments were conducted at 12 months. Scores were compared with 24 early treated HIV-infected infants in an observational group (OG). BSID-III assessments were also conducted for older children in an OG at 24 or 36 months. Cognitive, language and motor scaled and composite scores were analysed. RESULTS BSID-III scaled and composite scores were all higher in the IG apart from the gross motor scaled score (9.25 vs. 10, p = 0.1954). Receptive communication scaled score was significantly higher in the IG (10.96 vs. 9, p = 0.0331). IG composite scores were all higher than OG scores. OG children assessed at 24 or 36 months had lower composite scores in all subscales than 12-month OG scores. CONCLUSIONS Early treated HIV-infected children participating in a neurodevelopmental stimulation programme achieved higher BSID-III scores at 12 months compared with early treated HIV-infected children who did not receive the programme.
Collapse
Affiliation(s)
- Renate Strehlau
- Empilweni Services and Research Unit, Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Megan Burke
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tamryn van Aswegen
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Louise Kuhn
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, and The Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York City , New York, USA
| | - Joanne Potterton
- School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
5
|
Shiau S, Evans H, Strehlau R, Shen Y, Burke M, Liberty A, Coovadia A, Abrams EJ, Yin MT, Violari A, Kuhn L, Arpadi SM. Behavioral Functioning and Quality of Life in South African Children Living with HIV on Antiretroviral Therapy. J Pediatr 2020; 227:308-313.e2. [PMID: 32712285 PMCID: PMC8811608 DOI: 10.1016/j.jpeds.2020.07.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/01/2020] [Accepted: 07/20/2020] [Indexed: 11/22/2022]
Abstract
This study examined behavioral functioning and quality of life in South African children living with perinatally acquired HIV. Compared with controls, children living with perinatally acquired HIV had a higher mean total difficulties score assessed by the Strengths and Difficulties Questionnaire and lower mean quality of life scores assessed by the Pediatric Quality of Life Inventory.
Collapse
Affiliation(s)
- Stephanie Shiau
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ
| | - Henry Evans
- Department of Medicine, Division of Infectious Diseases, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY
| | - Renate Strehlau
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Yanhan Shen
- ICAP at Columbia University, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
| | - Megan Burke
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Afaaf Liberty
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
| | - Ashraf Coovadia
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elaine J Abrams
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY; G.H. Sergievsky Center, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY; Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Michael T Yin
- Department of Medicine, Division of Infectious Diseases, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY
| | - Avy Violari
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
| | - Louise Kuhn
- ICAP at Columbia University, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY; G.H. Sergievsky Center, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY
| | - Stephen M Arpadi
- ICAP at Columbia University, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY; G.H. Sergievsky Center, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY; Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa.
| |
Collapse
|