Timing of ART failed to affect neurodevelopmental outcomes in children

Issue: April 2012

SEATTLE — There were no differences in neurodevelopmental outcomes among children who had deferred antiretroviral therapy compared with children who immediately started antiretroviral therapy.

“HIV-positive children should be diagnosed and started on treatment during their first year of life,” Jintanat Ananworanich, MD, PhD, of HIV-NAT and the Thai Red Cross AIDS Research Center, said during a press conference here. “Our study provides information on what to do in older children who survive their HIV disease.”

HIV-positive children from Thailand and Cambodia, aged 1 to 12 years, who had CD4 counts of 15% to 24% and no AIDS-defining illness were randomly assigned to initiate ART immediately or when CD4 counts reached less than 15%. Children underwent neuropsychological testing, including the Beery Visual-Motor Integration, the Purdue Pegboard, Color Traits and child behavioral checklist. The Thai children also completed the Wechsler Intelligence Scale.

The study included 284 HIV-positive children and 164 HIV-negative children with a median age of 7 years. Females comprised 58% of the children, and 62% of the children were Thai. Median CD4 nadirs were 18% in the children who received immediate ART, and 15% in the children who received delayed ART.

At week 144, 48% of the children in the deferred arm had started ART. The median CD4 count was 33% in the group that had immediate ART and 24% in the group that had deferred ART. There were no significant differences between either of the arms for any of the neurodevelopmental scores. But both of the HIV-positive groups scored lower than the HIV-negative controls on the IQ and the Berry Visual-Motor Integration, but not the Purdue Pegboard or the Color Traits.

“The fact that we saw worse neurodevelopment outcomes in HIV-positive children compared to HIV-negative children suggests that HIV affects the brain,” Ananworanich said. “Even though these older children survived their infancy, there are still neurodevelopmental consequences related to HIV.”