Browsing by Author "Springer, Priscilla Estelle"
Now showing 1 - 2 of 2
Results Per Page
Sort Options
- ItemFive year neurodevelopment outcomes of perinatally HIV-infected children on early limited or deferred continuous antiretroviral therapy(Wiley Open Access, 2018) Laughton, Barbara; Cornell, Morna; Kidd, Martin; Springer, Priscilla Estelle; Dobbels, Els; Van Rensburg, Anita Janse; Otwombe, Kennedy; Babiker, Abdel; Gibb, Diana M.; Violari, Avy; Kruger, Mariana; Cotton, Mark F.Introduction: Early antiretroviral therapy (ART) has improved neurodevelopmental outcomes of HIV-infected (HIV-positive) children; however, little is known about the longer term outcomes in infants commencing early ART or whether temporary ART interruption might have long-term consequences. In the children with HIV early antiretroviral treatment (CHER) trial, HIVinfected infants ≤12 weeks of age with CD4 ≥25% were randomized to deferred ART (ART-Def); immediate time-limited ART for 40 weeks (ART-40W) or 96 weeks (ART-96W). ART was restarted in the time-limited arms for immunologic/clinical progression. Our objective was to compare the neurodevelopmental profiles in all three arms of Cape Town CHER participants. Methods: A prospective, longitudinal observational study was used. The Griffiths mental development scales (GMDS), which includes six subscales and a global score, were performed at 11, 20, 30, 42 and 60 months, and the Beery-Buktenica developmental tests for visual motor integration at 60 months. HIV-exposed uninfected (HEU) and HIV-unexposed (HU) children were enrolled for comparison. Mixed model repeated measures were used to compare groups over time, using quotients derived from standardized British norms. Results: In this study, 28 ART-Def, 35 ART-40W, 33 ART-96W CHER children, and 34 HEU and 39 HU controls were enrolled. GMDS scores over five years were similar between the five groups in all subscales except locomotor and general Griffiths (interaction p < 0.001 and p = 0.02 respectively), driven by early lower scores in the ART-Def arm. At 60 months, scores for all groups were similar in each GMDS scale. However, Beery visual perception scores were significantly lower in HIV-infected children (mean standard scores: 75.8 ART-Def, 79.8 ART-40W, 75.9 ART-96W) versus 84.4 in HEU and 90.5 in HU (p < 0.01)). Conclusions: Early locomotor delay in the ART-Def arm resolved by five years. Neurodevelopmental outcomes at five years in HIV-infected children on early time-limited ART were similar to uninfected controls, apart from visual perception where HIVinfected children scored lower. Poorer visual perception performance warrants further investigation.
- ItemNeurodevelopmental and behavioural outcome of the HIV-exposed uninfected infant and child(Stellenbosch : Stellenbosch University., 2020-03) Springer, Priscilla Estelle; Kruger, Mariana; Molteno, Christopher David; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.ENGLISH ABSTRACT: The first 1000 days of life represents a crucial phase for cognitive, language and emotional development. Indeed, early childhood development provides a foundation for educational and vocational success. Early screening and detection of developmental delay is therefore important, as timely intervention can improve school readiness. The human immunodeficiency virus (HIV) pandemic has been identified as a contributor to early developmental delay in low-and middle-income countries. In South Africa, successful vertical HIV-transmission prevention programmes have led to a substantial decrease in mother-to-child transmission rates. As a result, approximately one in four newborns are HIV-exposed but uninfected (HEU). However, the impact of both HIV exposure and anti-retroviral therapy on neurodevelopmental outcomes of HEU infants remains poorly understood. In particular, few prospective studies have combined developmental and behavioural assessments from infancy to early childhood. In response to this knowledge gap, a pilot study was performed to explore the feasibility of using the Griffiths Mental Development Scales to assess outcome in HEU compared to HIV-unexposed uninfected (HUU) infants. Following the initial pilot phase, mother-infant dyads were better matched for home language, cultural and maternal social characteristics and we extended infant assessments to include cognitive, motor, language and behavioural domains using the Bayley Scales of Infant and Toddler Development-3rd edition (BSID), as well as the Alarm Distress Baby Scale. The BSID was repeated at two-year follow-up, and behaviour was assessed using the Strengths and Difficulties Questionnaire. Despite similar performance in BSID motor, language and cognitive domains, more behavioural problems were reported by mothers of HUU children at 2-3 years old. Childhood stunting was associated with poorer motor and behavioural outcome, irrespective of HIV exposure. Based on initial findings, we further explored the use of the Molteno Adapted Scale (MAS) screening tool, and its correlations with the BSID at 11-14 months and 2-3 years of age in our study cohort. There was moderate correlation between the major domains of these tests; however, we were unable to test the diagnostic accuracy of the MAS, as too few participants had significant developmental delays. There was also increased discrepancy in scores of the assessment tools at the lower and upper ranges of the spectrum, which could potentially lead to under-identification of children at risk for delay. Lastly, we assessed the diagnostic accuracy of the Goodenough Drawing test screening tool (DAP) in a group of at-risk children at five years of age. The diagnostic accuracy of the DAP was sufficiently promising to justify its use as a research tool to detect visuo-perceptual and fine motor delay. High attrition rates and a small sample size were important limitations in our study. However, a major strength lies in the observation of the need for developmental surveillance and support for all children regardless of HIV exposure, especially those from socio-economically disadvantaged communities. Our findings could help South African policy makers justify initiatives encouraging multi-sectoral collaboration such as the Framework for Nurturing Care, aligning with both the fourth Sustainable Development Goal and the National Development Plan for 2030, which aims to “leave no child behind”.