Published online November 1, 2007
PEDIATRICS Vol. 120 Supplement November 2007, pp. S159-S160 (doi:10.1542/peds.2007-0846RRRR)
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IMMUNODEFICIENCY


A Prospective Controlled Study of Neurodevelopment in HIV-Uninfected Children Exposed to Combination Antiretroviral Drugs in Pregnancy

Joseph A. Church, MD

Los Angeles, CA

ABSTRACT

Alimenti A, Forbes JC, Oberlander TF, et al. Pediatrics. 2006;118(4). Available at: www.pediatrics.org/cgi/content/full/118/4/e1139

PURPOSE OF THE STUDY. The effective treatment of HIV-infected women with antiretroviral agents has dramatically reduced the incidence of HIV infection in their newborn infants. However, an ongoing concern has been the potential adverse effects of the antiretroviral agents themselves on the neurodevelopment of HIV-uninfected children who were exposed to combination HIV medications. The purpose of this study was to investigate the neurodevelopment of HIV-infected children exposed to combination anti-HIV therapy in pregnancy compared with children not exposed to this therapy.

STUDY POPULATION. A total of 39 antiretroviral therapy–exposed and 24 control children were assessed.

METHODS. This was a prospective, controlled, cross-sectional study. The Bailey Scales of Infant Development and Vineland Adaptive Behavior scales were performed at 18 to 36 months of age. Control children were born to HIV-uninfected women with similar anticipated social and economic backgrounds. Results were compared by using analysis of covariance and {chi}2 analysis.

RESULTS. All scores were lower for children who were exposed prenatally to antiretroviral therapy. However, when maternal substance use during pregnancy was controlled for, there were no significant differences between the groups in any of the domains assessed. Children in both groups who were exposed to maternal substance use scored significantly lower in most domains than children who were not exposed.

CONCLUSIONS. HIV and antiretroviral therapy–exposed HIV-uninfected children had lower development and adaptive behavior scores compared with children who were not exposed to HIV or anti-HIV drugs. It is important to note that these differences were not significant when maternal substance use was considered. In this prospective study, exposure to perinatal anti-HIV therapy was not associated with neurodevelopmental abnormalities.

REVIEWER COMMENTS. This small study demonstrated that maternal substance use impacted the neurodevelopment of children to a far greater extent than exposure to anti-HIV drugs. In this study, at least, any negative impact of antiretroviral drugs on infant neurodevelopment was masked by the maternal substance use. This is not to say that exposure to combination anti-HIV medications may not have an impact on childhood development. Studies with similar designs to this one, in larger numbers of children for whom maternal substance use is not a confounding factor, will be required to address this issue fully.