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HIV Antiretroviral Therapies During Pregnancy Don’t Harm Child’s Brain

malawi mother and infant

HIV therapies have little effect on a baby’s brain development, according to a new study of women who took antiretroviral therapies for HIV while pregnant or nursing.

An almost certain death sentence 30 years ago, having HIV today has lost its fatal sting. In just over 20 years, the development of antiretroviral therapies, or ART, has ensured that deadly outcomes for HIV-positive adults and children have decreased dramatically.

The randomized-control trial included 861 infants born to HIV-infected mothers in Malawi and Uganda who were taking a triple-antiretroviral drug regimen.

Tracking Cognitive Development

Researchers tracked the neurodevelopment of the children over a five-year period and compared the results to a separate group of children the same age and in the same area but who were not exposed or infected with the virus.

By comparing the two groups of children at 12, 24, 48, and 60 months, the research provides critical information on the outcomes of children exposed to antiretroviral therapies both in utero and while nursing over the first five years of life, says Michael Boivin, professor in the psychiatry, neurology, and ophthalmology departments at Michigan State University.

Using the Mullen Scales of Early Learning, or MSEL, researchers found no differences in children’s cognitive outcomes at 12, 24, and 48 months. The MSEL measures children’s ability to understand and express language, and assesses gross and fine motor skills, visual reception, and cognitive ability.

Researchers used the Kaufman Assessment Battery for children to do an in-depth neurocognitive evaluation at 48 and 60 months of age.

Researchers used both neurodevelopmental and neurocognitive assessments in tracking both groups of children. The assessments covered memory, visual–spatial processing, and problem solving, learning requiring immediate and delayed memory usage, subtests not dependent on the understanding of instructions in English, and a mix of processing skills.

Outcomes Reassuring

The findings indicate that the neurological development of the HIV-exposed and uninfected children of mothers with the disease receiving ART regimens were similar to the children that weren’t exposed or infected at all and living in comparable circumstances.

“We found that the more potent combination of ART treatments for pregnant mothers typically kept the mothers with HIV healthier than interrupted or non-ART intervention,” Boivin says. “Keeping the mothers healthy tended to result in better neurodevelopmental outcomes for their infants throughout early childhood.”

This outcome outweighs any risks posed by the drugs themselves to gestational and early neurodevelopment, Boivin says, adding the findings could have significant policy-making implications.

“This is the first time such neurodevelopmental outcomes are available for what has become the standard of care across sub-Saharan Africa. They are reassuring because prevention of mother-to-child transmission programs using new maternal triple antiretrovirals continue to be widely rolled out in sub-Saharan Africa and globally,”

Boivin says.

Prof Michael J Boivin, Phd, Limbika Maliwichi-Senganimalunje, MS, Lillian W Ogwang, MMed, Rachel Kawalazira, MMed, Prof Alla Sikorskii, PhD, Itziar Familiar-Lopez, PhD, Agatha Kuteesa, BS, Mary Nyakato, MS, Alex Mutebe, MS, Jackie L Namukooli, MPH, MacPherson Mallewa, PhD, Horacio Ruiseñor-Escudero, PhD, Jim Aizire, PhD, Prof Taha E Taha, PhD, Prof Mary G Fowler, MD
Neurodevelopmental effects of ante-partum and post-partum antiretroviral exposure in HIV-exposed and uninfected children versus HIV-unexposed and uninfected children in Uganda and Malawi: a prospective cohort study
The Lancet; DOI:https://doi.org/10.1016/S2352-3018(19)30083-9

Image: UK Department for International Development/Flickr