Language delays in children with prenatal exposure to HIV and antiretroviral therapy

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.