Neruodevelopmental Outcomes in Pre-School Children Living with HIV-1 Subtypes A and D in Uganda

Horacio Ruiseñor- Escudero, Alla Sikorskii, Itziar Familiar- Lopez, Deborah Persaud, Carrie Ziemniak, Noeline Nakasujja, Robert Opoka, Michael Boivin

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HIV is a neuropathogenic virus that may result in detrimental neurodevelopmental (ND) outcomes early in life. This is the first study to evaluate the effect of HIV-1 subtype on neurodevelopment of Ugandan pre-school children.


Neurodevelopment of 87 HIV-1 infected and 221 HIV exposed uninfected (HEU) Ugandan children aged 1.8 to 4.9 years was assessed using four scales of the Mullen Scales of Early Learning (MSEL), two scales of the Color Object Association Test (COAT), and one score of the Early Childhood Vigilance Test (ECVT). HIV-1 subtype was defined by phylogenetic analyses. General linear models were used to relate test scores to HIV-1 subtype (A versus D) while adjusting for relevant covariates. The scores were benchmarked against HEU group to facilitate the interpretation.


Seventy-one percent of children infected with subtype A vs. 60% of children with subtype D were currently on antiretroviral therapy (ART) (p=0.49). Children with HIV-1 subtype A infection were older when compared to subtype D (3.29 vs. 2.76 years, respectively, p=0.03), but similar regarding sex, socioeconomic status, weight-for-age z-score, CD4+ and CD8+ (% and total), viral load. No statistically significant differences by HIV-1 subtype were observed in the MSEL, COAT, and ECVT. Differences ≥0.33 of the standard deviation were observed for the MSEL Composite Score, Receptive Language (MSEL), and Total Memory (COAT).


In contrast to previously reported differences in ND outcomes of school-aged children by HIV-1 subtype, ND scores among pre-school children were similar for subtypes A and D, with few potential differences on language production and memory outcomes that favored subtype A. Further investigation with larger sample sizes and longitudinal follow-up is needed.

Original languageUndefined/Unknown
JournalPaediatrics and Child Health, East Africa
Publication statusPublished - 1 Dec 2018

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