article · AIDS
A prospective study in Migori, Kenya, tracked 293 breastfed children from birth up to 36 months to evaluate whether maternal dolutegravir-based antiretroviral therapy affects child neurodevelopment. Children who were HIV-exposed but uninfected were compared with children born to mothers without HIV, measuring cognitive, language, and motor outcomes using standard infant development scales at 24 and 36 months. Most HIV-exposed infants had in-utero exposure to dolutegravir. Overall development scores and growth trajectories showed no significant differences between the two groups. Although HIV-exposed children initially exhibited a higher risk of fine motor delay, this disparity disappeared after adjusting for socio-demographic factors. Both groups showed high rates of developmental delay, with over a third affected at 36 months, indicating that broader environmental and nutritional conditions strongly shape early development.
Evaluating the safety of antiretroviral regimens like dolutegravir is critical for maternal and child health policy. Demonstrating that neurodevelopmental delays in HIV-exposed infants are driven primarily by socio-demographic rather than biological drug-exposure factors helps reassure healthcare programmes. It also highlights the urgent need to address underlying nutritional and environmental barriers that hinder early child development across vulnerable communities.
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OBJECTIVE: To compare neurodevelopment through 36 months between breastfed children who are HIV-exposed and uninfected (CHEU) exposed to maternal dolutegravir (DTG)-based antiretroviral therapy (ART) and children born to mothers without HIV (CHU). METHODS: We enrolled a prospective cohort of pregnant women with and without HIV in Migori, Kenya, and followed infants to 36 months. Neurodevelopment was assessed at 24 and 36 months using the Bayley Scales of Infant and Toddler Development, Fourth Edition (Bayley-4). Outcomes included cognitive, language, and motor z-scores, domain-specific delay (z-score<-1SD), and any delay. Multivariable linear and Poisson regression compared CHEU and CHU, and mixed-effects models evaluated developmental trajectories. RESULTS: Among 293 children (CHEU = 149; CHU = 144), 49% were female and 9% were preterm. Breastfeeding at 12 months was similar between groups. Most CHEU (89%) were DTG-exposed in-utero. At 24 months, 43% had any delay (42% CHEU; 44% CHU), with similar prevalence at 36 months (37% CHEU; 35% CHU). Risk of fine motor delay was significantly higher among CHEU in unadjusted analyses but not after adjustment. Bayley-4 scores and trajectories did not differ between groups. CONCLUSION: Fine motor delay was more common among CHEU, but lack of difference in adjusted analyses suggests these delays were likely attributable to socio-demographic rather than biologic factors. The high prevalence of delays in both groups underscores the strong influence of environmental and nutritional factors on early child development.
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DOI: 10.1097/qad.0000000000004608
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