EARLY NEURODEVELOPMENT OF INFANTS BORN TO HIV-SEROPOSITIVE MOTHERS

Objective  To examine neurodevelopment during the first 12 months of life in infants born to HIV infected mothers.Methods Infants born to HIV infected mothers, who were receiving prenatal zidovudine monotherapy, were followed up at the Infectious Disease Clinic, Chiang Mai University Hospital and enrolled in this study. Neuro developmental assessment was administered atthe age of 12 months by using Bayley Scales of Infant Development (BSID). Confirmed HIV infection status was performed at 18 months of age. Results Thirty-nine infants, 10 infected and 29 uninfected, were studied. Demographic and perinatal characteristics including birth weight, length, head circumference, prematurity, maternal age, and maternal education were no different between the 2 groups. At 12 months, growth parameters of HIV infected and non-infected groups were not different, but Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) were significantly lower in the HIV-infected group than in the non-infected group (MDI=90 vs. 99, p = 0.001; PDI=83 vs. 96, p \< 0.001, respectively). In the HIV infected group, infants with symptomatic HIV infection had lower MDI and PDI scores than asymptomatic ones. Conclusion HIV infected infants showed early lower developmental scores. Neurodevelopment may be one of the early markers of disease progression within the first 12 months in infants with HIV infection. Chiang Mai Med Bull 2004;43(1):1-7.

The effectiveness of highly active antiretroviral therapy among HIV-infected children in Asian countries

Background: Worldwide, there are 2.1 million children under 15 years of age living with HIV infection. In the past five years, there has been significant progress in providing antiretroviral therapy (ART) to children in resource-limited countries. According to the World Health Organization, an estimated 200,000 children were receiving ART by the end of 2007.Objective: To conduct a general review of pediatric ART effectiveness in Asian countries.Methods: Published articles in PubMed and abstracts from the international HIV conferences were searched for articles related to pediatric ART in Asian countries from 1999 up to 2008.Results: Available reports consistently demonstrated beneficial outcomes of first-line antiretroviral therapy, including significant reductions in mortality and hospitalization rates, and good immunological and virological outcomes. However, there were limited data on the availability of second-line ART and the management of children who failed first-line regimens. There was also a need for improved access to early diagnostic testing and treatment in infancy, and more data on ART selection for children exposed to antiretrovirals for prevention of mother to child transmission.Conclusion: The highly active antiretroviral therapy is effective among HIV-infected children in Asia. Strategies for improved diagnosis and implementation of the life-saving antiretroviral programs including second -line ART, throughout Asia is encouraged.