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.
Michael Boivin, a Michigan State University professor in the Departments of Psychiatry, as well as Neurology and Ophthalmology, is studying how taking these therapies by pregnant or nursing mothers affect a childโs neurodevelopment.
Boivin led a randomized-control trial involving 861 infants born to HIV-infected mothers in Malawi and Uganda who were taking a triple-antiretroviral drug regimen. He tracked the neurodevelopment of the children over a 5-year period and compared the results to a separate group of children who were the same age and in the same area but had not been exposed or infected with the virus.
The study is published in The Lancet HIV, the top-ranked international journal in HIV/AIDS research.
By comparing the two groups of children at 12, 24, 48 and 60 months, Boivinโs 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.
Using the Mullen Scales of Early Learning, or MSEL, Boivinโs research found no differences in childrenโs cognitive outcomes at 12, 24 and 48 months. The MSEL measures childrenโs ability to understand and express language, and assesses gross and fine motor skills, visual reception and cognitive ability. They also used the Kaufman Assessment Battery for children to do an in-depth neurocognitive evaluation at 48 and 60 months of age.
Boivinโs research used both neurodevelopmental and neurocognitive assessments in tracking both groups of children. The assessments covered memory, visualโspatial 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.
Boivinโs findings indicated that the neurological development of theย HIV-exposed and uninfected children of mothers with the disease who were receiving ART regimens were similar to the children that werenโt exposed or infected at all and living in comparable circumstances.
โWe 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,โ Boivin said. โKeeping the mothers healthy tended to result in better neurodevelopmental outcomes for their infants throughout early childhood.”
According to Boivin, this outcome outweighs any risks posed by the drugs themselves to gestational and early neurodevelopment and his findings couldhave significant policy-making implications.
โThis is the first time such neurodevelopmental outcomes are available for what has become the standard of care across sub-Saharan Africa,โ Boivin said. โThey 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.โ
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