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HIV Therapies Are Giving Infected Children a Fighting Chance

The Kivuye district of northern Rwanda is predominantly agricultural. This view of the area looks toward Uganda.

An almost certain death sentence 30 years ago, having HIV today has lost its fatal sting. In just over 20 years, the development of Antiretroviral Therapies, or ART, has ensured that deadly outcomes for HIV-positive adults and children have decreased dramatically.

Michael Boivin, a Michigan State University professor in the Departments of Psychiatry, as well as Neurology and Ophthalmology, is studying how taking these therapies by pregnant or nursing mothers affect a child’s neurodevelopment.

Boivin led a randomized-control trial involving 861 infants born to HIV-infected mothers in Malawi and Uganda who were taking a triple-antiretroviral drug regimen. He tracked the neurodevelopment of the children over a 5-year period and compared the results to a separate group of children who were the same age and in the same area but had not been exposed or infected with the virus.

A close headshot of Boivin, he is wearing a blue shirt. There is a picture of children in the background.

Michael Boivin is a professor in the Department of Psychiatry and the Department of Neurology and Ophthalmology. Photo by G.L. Kohuth.

The study is published in The Lancet HIV, the top-ranked international journal in HIV/AIDS research.

By comparing the two groups of children at 12, 24, 48 and 60 months, Boivin’s research provides critical information on the outcomes of children exposed to antiretroviral therapies both in utero and while nursing over the first five years of life.

Using the Mullen Scales of Early Learning, or MSEL, Boivin’s research found no differences in children’s cognitive outcomes at 12, 24 and 48 months. The MSEL measures children’s ability to understand and express language, and assesses gross and fine motor skills, visual reception and cognitive ability. They also used the Kaufman Assessment Battery for children to do an in-depth neurocognitive evaluation at 48 and 60 months of age.

Boivin’s research used both neurodevelopmental and neurocognitive assessments in tracking both groups of children. The assessments covered memory, visual–spatial processing and problem solving, learning requiring immediate and delayed memory usage, subtests not dependent on the understanding of instructions in English, and a mix of processing skills.

Boivin’s findings indicated that the neurological development of the HIV-exposed and uninfected children of mothers with the disease who were receiving ART regimens were similar to the children that weren’t exposed or infected at all and living in comparable circumstances.

“We found that the more potent combination of ART treatments for pregnant mothers typically kept the mothers with HIV healthier than interrupted or non-ART intervention,” Boivin said. “Keeping the mothers healthy tended to result in better neurodevelopmental outcomes for their infants throughout early childhood.”

According to Boivin, this outcome outweighs any risks posed by the drugs themselves to gestational and early neurodevelopment and his findings could have significant policy-making implications.

“This is the first time such neurodevelopmental outcomes are available for what has become the standard of care across sub-Saharan Africa,” Boivin said. “They are reassuring because prevention of mother-to-child transmission programs using new maternal triple antiretrovirals continue to be widely rolled out in sub-Saharan Africa and globally.”

Laura Probyn, Michael Boivin, and Sarina Gleason via MSU Today

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