Department of Global Health, University of Washington, Seattle.
Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
J Acquir Immune Defic Syndr. 2023 May 1;93(1):7-14. doi: 10.1097/QAI.0000000000003165.
Early antiretroviral therapy (ART) during infancy reduces cognitive impairment due to HIV, but the extent of benefit is unclear.
Children were recruited from hospital and health centers providing HIV care and treatment in Nairobi, Kenya.
Cognitive, behavioral, and motor outcomes were assessed in children with HIV and early ART (<1 year), children with HIV and late ART (1.5-6 years), and children HIV-unexposed uninfected (CHUU). Domain z scores and odds neurobehavioral impairment (≤15th percentile in CHUU) were compared in adjusted analyses.
Children with HIV initiated ART at median ages 0.4 (early ART) and 3.5 years (late ART). Children were assessed at median ages 6.9 (CHUU, N = 61), 6.9 (early ART, N = 54), and 13.5 (late ART; N = 27) years. Children with late ART vs. children with early ART had significantly lower z scores in 7 domains, specifically global cognition, short-term memory, visuospatial processing, learning, nonverbal test performance, executive function, and motor skills (adjusted mean differences, -0.42 to -0.62, P values ≤ 0.05), and had higher odds impairment in 7 domains (adjusted odds ratios [aORs], 2.87 to 16.22, P values ≤ 0.05). Children with early ART vs. CHUU had lower z scores in 5 domains (global cognition, short-term memory, delayed memory, processing speed, and behavioral regulation [adjusted mean differences, -0.32 to -0.88, P values < 0.05]) and higher impairment for 2 domains (short-term memory [aOR, 3.88] and behavioral regulation [aOR 3.46], P values < 0.05). Children with late ART vs. CHUU had lower z scores in 8 domains (adjusted mean differences, -0.57 to -1.05, P values ≤ 0.05), and higher impairment in 7 domains (aORs 1.98 to 2.32, P values ≤ 0.05).
Early ART in the first year of life attenuates but does not eliminate the neurodevelopmental compromise of HIV.
婴儿期早期抗逆转录病毒治疗（ART）可降低 HIV 引起的认知障碍，但获益程度尚不清楚。
在肯尼亚内罗毕的医院和卫生中心招募了接受 HIV 护理和治疗的儿童。
对 HIV 患儿和早期 ART（<1 岁）、HIV 患儿和晚期 ART（1.5-6 岁）以及 HIV 未感染未感染的儿童（CHUU）进行认知、行为和运动结局评估。在调整分析中比较了各域 z 评分和神经行为损伤的几率（CHUU 中≤第 15 百分位数）。
HIV 患儿的 ART 中位年龄为 0.4 岁（早期 ART）和 3.5 岁（晚期 ART）。儿童的中位年龄分别为 6.9 岁（CHUU，N=61）、6.9 岁（早期 ART，N=54）和 13.5 岁（晚期 ART；N=27）。与早期 ART 患儿相比，晚期 ART 患儿在 7 个领域的 z 评分明显较低，特别是整体认知、短期记忆、视觉空间处理、学习、非语言测试表现、执行功能和运动技能（调整后的平均差异，-0.42 至-0.62，P 值≤0.05），且 7 个领域的神经行为损伤几率较高（调整后的比值比[aOR]，2.87 至 16.22，P 值≤0.05）。与 CHUU 相比，早期 ART 患儿在 5 个领域的 z 评分较低（整体认知、短期记忆、延迟记忆、处理速度和行为调节[调整后的平均差异，-0.32 至-0.88，P 值<0.05]），2 个领域的神经行为损伤几率较高（短期记忆[aOR，3.88]和行为调节[aOR，3.46]，P 值<0.05）。与 CHUU 相比，晚期 ART 患儿在 8 个领域的 z 评分较低（调整后的平均差异，-0.57 至-1.05，P 值≤0.05），且 7 个领域的神经行为损伤几率较高（aORs 1.98 至 2.32，P 值≤0.05）。
婴儿期第一年的早期 ART 可减轻但不能消除 HIV 引起的神经发育损伤。
