Early antiretroviral therapy reduces severity but does not eliminate neurodevelopmental compromise in children with HIV

J Acquir Immune Defic Syndr. 2023 Jan 23. doi: 10.1097/QAI.0000000000003165. Online ahead of print.


Background: Early antiretroviral therapy (ART) during infancy reduces cognitive impairment due to HIV, but the extent of benefit is unclear.

Setting: Children were recruited from hospital and health centers providing HIV care and treatment in Nairobi, Kenya.

Methods: Cognitive, behavioral and motor outcomes were assessed in children with HIV (CWHIV) and early-ART (<1 year), late-ART (1.5-6 years) and children HIV-unexposed uninfected (CHUU). Domain z-scores and odds neurobehavioral impairment (≤15th percentile in CHUU) were compared in adjusted analyses.

Results: CWHIV initiated ART at median age 0.4 (early-ART) and 3.5 years (late-ART). Children were assessed at median age 6.9 (CHUU; N=61), 6.9 (early-ART; N=54) and 13.5 (late-ART; N=27) years. Children with late- vs. early-ART had significantly lower z-scores in 7 domains, specifically, global cognition, short-term memory, visuospatial processing, learning, nonverbal test performance, executive function and motor (adjusted mean differences [AMD], -0.42 to -0.62, P-values ≤0.05), and had higher odds impairment in 7 domains (adjusted odds ratios [aORs]. 2.87 to 16.22, P-values ≤0.05). Children with early-ART vs. CHUU had lower z-scores in 5 domains (global cognition, short-term memory, delayed memory, processing speed, behavioral regulation [AMD, -0.32 to -0.88, P-values <0.05]), and higher impairment for 2 (short-term memory [aOR, 3.88] and behavioral regulation [aOR 3.46], P-values <0.05). Children with late-ART vs. CHUU had lower z-scores in 8 domains (AMD, -0.57 to -1.05, P-values ≤0.05), and higher impairment in 7 domains (aORs 1.98 to 2.32, P-values ≤0.05).

Conclusion: Early ART in the first year of life attenuates but does not eliminate neurodevelopmental compromise of HIV.