Neurodevelopmental outcomes at preschool age : A 5 year follow up study of a cohort born to mothers participating in the PMTCT program in Harare, Zimbabwe

Abstract

Background and purpose. The relationship between paediatric HIV infection and neurodevelopment has been studied largely in developed countries even if the burden of paediatric HIV is in Sub -Sahara Africa. This study assessed cognitive outcome at preschool age in Zimbabwean children, enrolled from a national PMTCT program, with vertically transmitted HIV type 1 infection who had been followed up for 5 years. Methods. We assessed cognitive function in 278 preschool children with Kaufman short form of McCarthy Scales of Children`s Abilities (MSCA). Four groups were identified: 25 with HIV infection, 94 HIV negative born to HIV positive mothers (seroreverter), 126 HIV negative born to HIV negative mothers (controls) and 33 with unknown status. All children had been previously screened in infancy for neurodevelopment using Bayley Infant Neurodevelopmental Screener [BINS]; 115 had received prophylactic single dose Nevirapine at delivery, but none were on antiretroviral treatment. Results. Cognitive impairment was observed in 24 children (8.6%) without significant difference between the groups. The family income of less than 30 US dollars per month, having a teenage mother and renting a house was associated with cognitive impairment. Mean General Cognitive Index(GCI) subtests scores were significantly lower between seroreverter and HIV negative children in specific subtests representative of verbal, perceptual performance and quantitative performance.HIV infected children were significantly more stunted , had more skin disorders, and lymphadenopathy compared to their uninfected peers. Maternal age was predictive of lower GCI scores. Correlation between BINS high risk score and GCI was observed between the ages 3 to 4 months. Conclusion. The Kaufmann short form of MSCA is a simple cognitive screening tool for preschool children, however it should be complemented by a good neurodevelopmental screening tool in the first year of life.HIV infected children who survive to preschool age did not manifest lower cognitive scores than established child norms. Chronic malnutrition as indexed by stunting was associated with poor cognitive function at preschool age. BINS if performed in the first 6 months of life, was predictive of later cognitive performance particularly in HIV infected children. Therefore comprehensive interventions addressing early diagnosis and treatment for both childhood HIV and malnutrition could result in significant improvement in cognitive function.