Abstract:
Catherine Wedderburn and colleagues’ birth cohort
study1 makes an important contribution to the
current understanding of the neurodevelopment—
and particularly the language development—of the
expanding population of children with prenatal exposure
to and antiretroviral therapy (ART). The aim of
the study was to compare the neurodevelopmental
outcomes of HIV-exposed uninfected children with
an HIV-unexposed uninfected group at 6 months and
24 months of age. Using a large cohort from two lowresourced
settings in the Western Cape province of South
Africa, Wedderburn and colleagues’ study is the first to
show clear delays in receptive and expressive language
at 24 months, measured on the Bayley Scales of Infant
and Toddler Development, third edition (BSID-III),
in the absence of any other neurodevelopmental
delay. The group of HIV-exposed uninfected children,
controlled for male sex bias, showed increased odds
of clinically significant delays in receptive language
(odds ratio 1·96 [95% CI 1·09 to 3·52]) and expressive
language (2·14 [1·11 to 4·15]) at 2 years of age compared
with HIV-unexposed children. Among several subgroup
analyses done, only maternal immunosuppression
was
significantly associated with increased prevalence of
receptive and expressive language delays, with maternal
CD4 cell counts of 500 cells per mL or less associated
with increased likelihood of such delays. These
findings advance our understanding of the language
development of HIV-exposed uninfected children in
several ways.
