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Neurodevelopmental status and prenatal antiretroviral exposure in HIV-exposed uninfected infants
Presented by Paige Williams, United States.
P. Williams1, M. Marino2, K. Malee3, L. Mofenson4, and the PACTG/IMPAACT 219C Team
1Harvard School of Public Health, Center for Biostatistics in AIDS Research, Boston, United States, 2Harvard School of Public Health, Department of Biostatistics, Boston, United States, 3Childrens Memorial Hospital, Northwestern University, Chicago, United States, 4National Institute of Child Health and Human Devevlopment, Pediatric, Adolescent and Maternal AIDS Branch, Rockville, United States
Background: Antiretroviral (ARV) drugs are routinely provided to HIV-infected pregnant women to prevent HIV mother-to-child transmission (MTCT). While ARV use has significantly reduced MTCT to <2% in the U.S., it remains crucial to monitor for any unanticipated consequences of in utero ARV exposure on uninfected infants.
Methods: We studied neurodevelopmental function in HIV-exposed uninfected children enrolled in PACTG 219/219C, a multi-site prospective cohort study. Cognitive and motor functioning were assessed with the Bayley Scales of Infant Development. ARV exposure information was collected during pregnancy or within the first year of life. Linear regression methods were used to evaluate the association of in utero ARV exposure on Mental Development Index (MDI) and Psychomotor Development Index (PDI) at age 2 years, controlling for potential confounders: test version (Bayley I or II); age; race; primary language; gender; primary caregiver; caregiver education level; low birth weight (LBW <2500g); geographical and urban/rural location; birth year; and maternal antenatal substance use (heroin, cocaine, stimulants).
Results: Among 1840 infants born between 1993-2006, 1694 (92%) were exposed and 146 (8%) unexposed to ARV in utero. After controlling for confounders, children exposed in utero to any ARV had similar MDI and PDI scores as ARV-unexposed children (adjusted mean MDI=94.0 vs 91.6, p=0.09, PDI=93.7 vs 94.0, p=0.85). MDI scores were higher for ARV-exposed than unexposed among those with LBW (adjusted mean=91.9 vs 82.5, p=0.01). Maternal antenatal substance use was reported for 17% of mothers, but was not associated with MDI or PDI scores. All other covariates showed significant associations with MDI scores except primary caregiver,and with PDI scores except race and primary language.
Conclusions: No decline in cognitive or motor function was observed for infants with in utero ARV exposure compared to unexposed. While these results are reassuring, continued evaluation of uninfected infants with in utero ARV exposure for late outcomes is important.
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