In Utero Efavirenz Exposure and Neurodevelopmental Outcomes in HIV-exposed Uninfected Children in Botswana.

Autor:	Cassidy AR; From the Center for Neuropsychology, Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts.; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts., Williams PL; Harvard T. H. Chan School of Public Health, Boston, Massachusetts., Leidner J; Goodtables Consulting, Norman, Oklahoma., Mayondi G; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana., Ajibola G; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana., Makhema J; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana., Holding PA; Educate Africa, Mombasa, Kenya., Powis KM; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.; Harvard T. H. Chan School of Public Health, Boston, Massachusetts.; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.; Massachusetts General Hospital, Boston, Massachusetts., Batlang O; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana., Petlo C; Ministry of Health and Wellness, Gaborone, Botswana., Shapiro R; From the Center for Neuropsychology, Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts.; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.; Harvard T. H. Chan School of Public Health, Boston, Massachusetts.; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts., Kammerer B; From the Center for Neuropsychology, Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts.; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts., Lockman S; From the Center for Neuropsychology, Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts.; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.; Harvard T. H. Chan School of Public Health, Boston, Massachusetts.; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts.
Jazyk:	angličtina
Zdroj:	The Pediatric infectious disease journal [Pediatr Infect Dis J] 2019 Aug; Vol. 38 (8), pp. 828-834.
DOI:	10.1097/INF.0000000000002332
Abstrakt:	Background: Minimal data exist related to neurodevelopment after in utero exposure to Efavirenz (EFV). We sought to compare neurodevelopmental outcomes in HIV-exposed/uninfected (HEU) children with in utero exposure to EFV-based triple antiretroviral treatment (ART) versus non-EFV-based ART, and to examine whether timing of initial EFV exposure is associated with neurodevelopment deficits. Methods: Women living with HIV who had received EFV-based ART during pregnancy and whose HEU newborn participated in a prior study were reconsented for their HEU toddler to undergo neurodevelopmental testing at 24 months old. We administered the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III), Developmental Milestones Checklist (DMC) and Profile of Social Emotional Development (PSED). We compared outcomes to previously-collected data from a cohort of 24-month-old HEU children with in utero exposure to non-EFV-based ART. Adjusted general linear models were used to compare mean outcomes. Results: Our analysis included 493 HEU children (126 EFV-exposed, 367 EFV-unexposed). Adjusted mean scores for the EFV-exposed group were worse than the EFV-unexposed group on BSID-III Receptive Language (adjusted means = 21.5 vs. 22.5, P = 0.05), DMC Locomotor (30.7 vs. 32.0, P < 0.01) and Fine Motor scales (17.8 vs. 19.2, P < 0.01); and PSED (11.7 vs. 9.9, P = 0.02); but better on the DMC Language scale (17.6 vs. 16.5, P = 0.01). Earlier (vs. later) EFV exposure was associated with worse scores on the BSID-III Receptive Language scale (20.7 vs. 22.2, P = 0.02). Conclusions: HEU children exposed in utero to EFV-based ART may be at higher risk for neurodevelopmental and social-emotional deficits than HEU children exposed to non-EFV-based ART.
Databáze:	MEDLINE
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