Timing of ART failed to affect neurodevelopmental outcomes in children

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.”

For more information:

Ananworanich J. #24. Presented at: 19th Conference on Retroviruses and Opportunistic Infections; March 3-8, 2012; Seattle.

Disclosure: Dr. Ananworanich reports no relevant financial disclosures.