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Magondo N, Meintjes EM, Warton FL, Little F, van der Kouwe AJW, Laughton B, Jankiewicz M, Holmes MJ. Distinct alterations in white matter properties and organization related to maternal treatment initiation in neonates exposed to HIV but uninfected. Sci Rep 2024; 14:8822. [PMID: 38627570 PMCID: PMC11021525 DOI: 10.1038/s41598-024-58339-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 03/27/2024] [Indexed: 04/19/2024] Open
Abstract
HIV exposed-uninfected (HEU) infants and children are at risk of developmental delays as compared to HIV uninfected unexposed (HUU) populations. The effects of exposure to in utero HIV and ART regimens on the HEU the developing brain are not well understood. In a cohort of 2-week-old newborns, we used diffusion tensor imaging (DTI) tractography and graph theory to examine the influence of HIV and ART exposure in utero on neonate white matter integrity and organisation. The cohort included HEU infants born to mothers who started ART before conception (HEUpre) and after conception (HEUpost), as well as HUU infants from the same community. We investigated HIV exposure and ART duration group differences in DTI metrics (fractional anisotropy (FA) and mean diffusivity (MD)) and graph measures across white matter. We found increased MD in white matter connections involving the thalamus and limbic system in the HEUpre group compared to HUU. We further identified reduced nodal efficiency in the basal ganglia. Within the HEUpost group, we observed reduced FA in cortical-subcortical and cerebellar connections as well as decreased transitivity in the hindbrain area compared to HUU. Overall, our analysis demonstrated distinct alterations in white matter integrity related to the timing of maternal ART initiation that influence regional brain network properties.
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Affiliation(s)
- Ndivhuwo Magondo
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Cape Town, South Africa.
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
| | - Ernesta M Meintjes
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Cape Town, South Africa.
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
- Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa.
| | - Fleur L Warton
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Francesca Little
- Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
| | - Andre J W van der Kouwe
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Cape Town, South Africa
- A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MI, USA
| | - Barbara Laughton
- Department of Paediatrics and Child Health and Tygerberg Children's Hospital, Faculty of Medicine and Health Sciences, Family Centre for Research with Ubuntu, Stellenbosch University, Stellenbosch, South Africa
| | - Marcin Jankiewicz
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa
- ImageTech, Simon Fraser University, Surrey, BC, Canada
| | - Martha J Holmes
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- ImageTech, Simon Fraser University, Surrey, BC, Canada
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Madzime J, Jankiewicz M, Meintjes EM, Torre P, Laughton B, van der Kouwe AJW, Holmes M. Reduced white matter maturation in the central auditory system of children living with HIV. Front Neuroimaging 2024; 3:1341607. [PMID: 38510428 PMCID: PMC10951401 DOI: 10.3389/fnimg.2024.1341607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/15/2024] [Indexed: 03/22/2024]
Abstract
Introduction School-aged children experience crucial developmental changes in white matter (WM) in adolescence. The human immunodeficiency virus (HIV) affects neurodevelopment. Children living with perinatally acquired HIV (CPHIVs) demonstrate hearing and neurocognitive impairments when compared to their uninfected peers (CHUUs), but investigations into the central auditory system (CAS) WM integrity are lacking. The integration of the CAS and other brain areas is facilitated by WM fibers whose integrity may be affected in the presence of HIV, contributing to neurocognitive impairments. Methods We used diffusion tensor imaging (DTI) tractography to map the microstructural integrity of WM between CAS regions, including the lateral lemniscus and acoustic radiation, as well as between CAS regions and non-auditory regions of 11-year-old CPHIVs. We further employed a DTI-based graph theoretical framework to investigate the nodal strength and efficiency of the CAS and other brain regions in the structural brain network of the same population. Finally, we investigated associations between WM microstructural integrity outcomes and neurocognitive outcomes related to auditory and language processing. We hypothesized that compared to the CHUU group, the CPHIV group would have lower microstructural in the CAS and related regions. Results Our analyses showed higher mean diffusivity (MD), a marker of axonal maturation, in the lateral lemniscus and acoustic radiations, as well as WM between the CAS and non-auditory regions predominantly in frontotemporal areas. Most affected WM connections also showed higher axial and radial diffusivity (AD and RD, respectively). There were no differences in the nodal properties of the CAS regions between groups. The MD of frontotemporal and subcortical WM-connected CAS regions, including the inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, and internal capsule showed negative associations with sequential processing in the CPHIV group but not in the CHUU group. Discussion The current results point to reduced axonal maturation in WM, marked by higher MD, AD, and RD, within and from the CAS. Furthermore, alterations in WM integrity were associated with sequential processing, a neurocognitive marker of auditory working memory. Our results provide insights into the microstructural integrity of the CAS and related WM in the presence of HIV and link these alterations to auditory working memory.
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Affiliation(s)
- Joanah Madzime
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Marcin Jankiewicz
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa
- Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa
| | - Ernesta M. Meintjes
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa
| | - Peter Torre
- School of Speech, Language, and Hearing Sciences, College of Health and Human Services, San Diego, CA, United States
| | - Barbara Laughton
- Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Andre J. W. van der Kouwe
- A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States
| | - Martha Holmes
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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Mudra Rakshasa-Loots A, Naidoo S, Hamana T, Fanqa B, van Wyhe KS, Lindani F, van der Kouwe AJW, Glashoff R, Kruger S, Robertson F, Cox SR, Meintjes EM, Laughton B. Multi-modal analysis of inflammation as a potential mediator of depressive symptoms in young people with HIV: The GOLD depression study. PLoS One 2024; 19:e0298787. [PMID: 38386679 PMCID: PMC10883559 DOI: 10.1371/journal.pone.0298787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
People living with HIV are at three times greater risk for depressive symptoms. Inflammation is a notable predictor of depression, and people with HIV exhibit chronic inflammation despite antiretroviral therapy. We hypothesised that inflammatory biomarkers may mediate the association between HIV status and depressive symptoms. Participants (N = 60, 53% girls, median [interquartile range (IQR)] age 15.5 [15.0, 16.0] years, 70% living with HIV, of whom 90.5% were virally-suppressed) completed the nine-item Patient Health Questionnaire (PHQ-9). We measured choline and myo-inositol in basal ganglia, midfrontal gray matter, and peritrigonal white matter using magnetic resonance spectroscopy, and 16 inflammatory proteins in blood serum using ELISA and Luminex™ multiplex immunoassays. Using structural equation mediation modelling, we calculated standardised indirect effect estimates with 95% confidence intervals. Median [IQR] total PHQ-9 score was 3 [0, 7]. HIV status was significantly associated with total PHQ-9 score (B = 3.32, p = 0.022). Participants with HIV showed a higher choline-to-creatine ratio in the basal ganglia than those without HIV (β = 0.86, pFDR = 0.035). In blood serum, participants with HIV showed higher monocyte chemoattractant protein-1 (MCP-1, β = 0.59, pFDR = 0.040), higher chitinase-3 like-1 (YKL-40, β = 0.73, pFDR = 0.032), and lower interleukin-1beta (IL-1β, β = -0.67, pFDR = 0.047) than those without HIV. There were no significant associations of any biomarkers with total PHQ-9 score. None of the indirect effects were significant, mediating <13.1% of the association. Findings remained consistent when accounting for age, gender, and time between neuroimaging and PHQ-9 administration. Using a robust analytical approach in a community-based sample, we have shown that participants living with HIV reported greater depressive symptoms than those without HIV, but we did not find that neuroimaging and blood biomarkers of inflammation significantly mediated this association. Further studies with participants experiencing severe depression may help to elucidate the links between HIV, inflammation, and depression.
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Affiliation(s)
- Arish Mudra Rakshasa-Loots
- Family Centre for Research with Ubuntu (FAMCRU), Tygerberg Hospital, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- Edinburgh Neuroscience, School of Biomedical Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Shalena Naidoo
- Family Centre for Research with Ubuntu (FAMCRU), Tygerberg Hospital, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Thandi Hamana
- Family Centre for Research with Ubuntu (FAMCRU), Tygerberg Hospital, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- Division of Biomedical Engineering, Biomedical Engineering Research Centre, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Busiswa Fanqa
- Family Centre for Research with Ubuntu (FAMCRU), Tygerberg Hospital, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Kaylee S. van Wyhe
- Family Centre for Research with Ubuntu (FAMCRU), Tygerberg Hospital, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- ACSENT Lab, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Filicity Lindani
- Family Centre for Research with Ubuntu (FAMCRU), Tygerberg Hospital, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Andre J. W. van der Kouwe
- Division of Biomedical Engineering, Biomedical Engineering Research Centre, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Radiology, Harvard Medical School, Boston, MA, United States of America
| | - Richard Glashoff
- Division of Medical Microbiology, Stellenbosch University, Cape Town, South Africa
- National Health Laboratory Service (NHLS), Tygerberg Business Unit, Cape Town, South Africa
| | - Sharon Kruger
- Family Centre for Research with Ubuntu (FAMCRU), Tygerberg Hospital, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Frances Robertson
- Division of Biomedical Engineering, Biomedical Engineering Research Centre, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Cape Universities Body Imaging Centre, Cape Town, South Africa
| | - Simon R. Cox
- Lothian Birth Cohorts group, Department of Psychology, The University of Edinburgh, Edinburgh, United Kingdom
| | - Ernesta M. Meintjes
- Division of Biomedical Engineering, Biomedical Engineering Research Centre, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Cape Universities Body Imaging Centre, Cape Town, South Africa
| | - Barbara Laughton
- Family Centre for Research with Ubuntu (FAMCRU), Tygerberg Hospital, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
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Magondo N, Meintjes EM, Warton FL, Little F, van der Kouwe AJ, Laughton B, Jankiewicz M, Holmes MJ. Distinct alterations in white matter properties and organization related to maternal treatment initiation in neonates exposed to HIV but uninfected. bioRxiv 2024:2024.01.11.575169. [PMID: 38260347 PMCID: PMC10802593 DOI: 10.1101/2024.01.11.575169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
HIV exposed-uninfected (HEU) infants and children are at risk of developmental delays as compared to uninfected unexposed (HUU) populations. The effects of exposure to in utero HIV and ART regimens on the HEU the developing brain are not well understood. In a cohort of 2-week-old newborns, we used diffusion tensor imaging (DTI) tractography and graph theory to examine the influence of HIV and ART exposure in utero on neonate white matter integrity and organisation. The cohort included HEU infants born to mothers who started ART before conception (HEUpre) and after conception (HEUpost), as well as HUU infants from the same community. We investigated HIV exposure and ART duration group differences in DTI metrics (fractional anisotropy (FA) and mean diffusivity (MD)) and graph measures across white matter. We found increased MD in white matter connections involving the thalamus and limbic system in the HEUpre group compared to HUU. We further identified reduced nodal efficiency in the basal ganglia. Within the HEUpost group, we observed reduced FA in cortical-subcortical and cerebellar connections as well as decreased transitivity in the hindbrain area compared to HUU. Overall, our analysis demonstrated distinct alterations in white matter integrity related to the timing of maternal ART initiation that influence regional brain network properties.
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Affiliation(s)
- Ndivhuwo Magondo
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Ernesta M. Meintjes
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa
| | - Fleur L. Warton
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Francesca Little
- Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
| | - Andre J.W. van der Kouwe
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA,USA
- Department of Radiology, Harvard Medical School, Boston, MI, USA
| | - Barbara Laughton
- Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health and Tygerberg Children’s Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch,South Africa
| | - Marcin Jankiewicz
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa
- ImageTech, Simon Fraser University, Surrey, BC, Canada
| | - Martha J. Holmes
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- ImageTech, Simon Fraser University, Surrey, BC, Canada
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Mudra Rakshasa-Loots A, van Wyhe KS, Naidoo S, Daizana N, Laughton B, Boyana T. Taking lead from the community: What do young people living with HIV want us to research? PLOS Glob Public Health 2023; 3:e0002605. [PMID: 38079383 PMCID: PMC10712858 DOI: 10.1371/journal.pgph.0002605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/14/2023] [Indexed: 02/12/2024]
Abstract
Priority setting workshops enable researchers to take the lead from people with relevant lived experience, and design research which authentically responds to community needs. Large-scale global priority setting exercises have previously identified key research questions related to paediatric and adolescent HIV treatment, prevention, and service delivery. However, priority setting workshops focused on the needs of young people living with HIV are lacking in southern Africa. Here, we report the outcome of a priority setting workshop organised in Cape Town, South Africa with 19 young people living with HIV and their parents and caregivers. Workshops were facilitated by trained research and clinical staff, who provided a plain-language introduction to research questions for the attendees. During the day-long workshop, attendees developed a list of research questions concerning HIV-related physical health, mental health, and psychosocial support and later voted on the order of importance for the questions which they had collectively identified. Facilitators did not prompt any questions or amend the phrasing of questions generated by the attendees. A cure for HIV was highlighted as the most important research priority for young people living with HIV. Other priorities for young people included the effects of antiretroviral therapy on the body, the brain, and their social relationships, causes of emotional issues such as depression and mood swings, and potential interventions to reduce HIV-related stigma in schools through positive education for teachers and students. Research priorities for parents and caregivers included improving antiretroviral adherence through long-acting injections, mental health impacts of HIV status disclosure without consent, and improving support provided by local community clinics. The research questions identified through this workshop may be used by researchers to develop future studies which truly benefit young people living with HIV in South Africa and beyond.
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Affiliation(s)
- Arish Mudra Rakshasa-Loots
- Family Centre for Research with Ubuntu (FAMCRU), Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- Edinburgh Neuroscience, School of Biomedical Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Kaylee S. van Wyhe
- Family Centre for Research with Ubuntu (FAMCRU), Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- ACSENT Lab, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Shalena Naidoo
- Family Centre for Research with Ubuntu (FAMCRU), Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Ntuthu Daizana
- Family Centre for Research with Ubuntu (FAMCRU), Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Barbara Laughton
- Family Centre for Research with Ubuntu (FAMCRU), Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Tembela Boyana
- Family Centre for Research with Ubuntu (FAMCRU), Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
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Graham AS, Ben-Azu B, Tremblay MÈ, Torre P, Senekal M, Laughton B, van der Kouwe A, Jankiewicz M, Kaba M, Holmes MJ. A review of the auditory-gut-brain axis. Front Neurosci 2023; 17:1183694. [PMID: 37600010 PMCID: PMC10435389 DOI: 10.3389/fnins.2023.1183694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Hearing loss places a substantial burden on medical resources across the world and impacts quality of life for those affected. Further, it can occur peripherally and/or centrally. With many possible causes of hearing loss, there is scope for investigating the underlying mechanisms involved. Various signaling pathways connecting gut microbes and the brain (the gut-brain axis) have been identified and well established in a variety of diseases and disorders. However, the role of these pathways in providing links to other parts of the body has not been explored in much depth. Therefore, the aim of this review is to explore potential underlying mechanisms that connect the auditory system to the gut-brain axis. Using select keywords in PubMed, and additional hand-searching in google scholar, relevant studies were identified. In this review we summarize the key players in the auditory-gut-brain axis under four subheadings: anatomical, extracellular, immune and dietary. Firstly, we identify important anatomical structures in the auditory-gut-brain axis, particularly highlighting a direct connection provided by the vagus nerve. Leading on from this we discuss several extracellular signaling pathways which might connect the ear, gut and brain. A link is established between inflammatory responses in the ear and gut microbiome-altering interventions, highlighting a contribution of the immune system. Finally, we discuss the contribution of diet to the auditory-gut-brain axis. Based on the reviewed literature, we propose numerous possible key players connecting the auditory system to the gut-brain axis. In the future, a more thorough investigation of these key players in animal models and human research may provide insight and assist in developing effective interventions for treating hearing loss.
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Affiliation(s)
- Amy S. Graham
- Imaging Sciences, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, Cape Town, South Africa
| | - Benneth Ben-Azu
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
- Department of Pharmacology, Faculty of Basic Medical Sciences, College of Health Sciences, Delta State University, Abraka, Delta State, Nigeria
| | - Marie-Ève Tremblay
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
- Département de Médecine Moléculaire, Université Laval, Québec City, QC, Canada
- Axe Neurosciences, Centre de Recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada
- Neurology and Neurosurgery Department, McGill University, Montreal, QC, Canada
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada
- Centre for Advanced Materials and Related Technology (CAMTEC), University of Victoria, Victoria, BC, Canada
- Institute for Aging and Lifelong Health, University of Victoria, Victoria, BC, Canada
| | - Peter Torre
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA, United States
| | - Marjanne Senekal
- Department of Human Biology, Division of Physiological Sciences, University of Cape Town, Cape Town, South Africa
| | - Barbara Laughton
- Family Clinical Research Unit, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Andre van der Kouwe
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States
- Department of Radiology, Harvard Medical School, Boston, MA, United States
| | - Marcin Jankiewicz
- Imaging Sciences, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, Cape Town, South Africa
| | - Mamadou Kaba
- Department of Pathology, Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Martha J. Holmes
- Imaging Sciences, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, Cape Town, South Africa
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- ImageTech, Simon Fraser University, Surrey, BC, Canada
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Nwosu EC, Holmes MJ, Cotton MF, Dobbels E, Little F, Laughton B, van der Kouwe A, Robertson F, Meintjes EM. Correction to: Similar cortical morphometry trajectories from 5 to 9 years in children with perinatal HIV who started treatment before age 2 years and uninfected controls. BMC Neurosci 2023; 24:36. [PMID: 37438704 DOI: 10.1186/s12868-023-00802-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Affiliation(s)
- Emmanuel C Nwosu
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa.
| | - Martha J Holmes
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Mark F Cotton
- Department of Pediatrics and Child Health, Family Centre for Research With Ubuntu (FAMCRU), Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Els Dobbels
- Department of Pediatrics and Child Health, Family Centre for Research With Ubuntu (FAMCRU), Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Francesca Little
- Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
| | - Barbara Laughton
- Department of Pediatrics and Child Health, Family Centre for Research With Ubuntu (FAMCRU), Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Andre van der Kouwe
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
- A. A. Martinos Centre for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Frances Robertson
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa
| | - Ernesta M Meintjes
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa.
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
- Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa.
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Shivakoti R, Laughton B, Shafiq M, Schoeman E, Glashoff RH, Barnabas S, Fry S, Leu CS, Wang S, Bode L, Aldrovandi G, Kuhn L, Slogrove AL. Feasibility Study of a Powder-Based Supplement Intervention for a future Synbiotic Trial in Breastfed Children from South Africa. Res Sq 2023:rs.3.rs-2842773. [PMID: 37293067 PMCID: PMC10246288 DOI: 10.21203/rs.3.rs-2842773/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Children who are HIV-exposed uninfected (HEU), i.e., born to mothers living with HIV despite not acquiring HIV infection themselves, have increased morbidity and mortality. Data suggests that the breastmilk profile, and more specifically human milk oligosaccharide (HMO) composition, differ by maternal HIV status and may partly help explain this increased risk. We are currently conducting an HMO-based synbiotic randomized trial in breastfed children HEU, the MIGH-T MO study (ClinicalTrials.gov Identifier: NCT05282485), to assess the impact on health outcomes of children HEU. Here, we report our experience from a study of the feasibility and acceptability of a powder-based intervention given to breastfeeding children, conducted prior to the initiation of MIGH-T MO. Methods 10 mothers living with HIV and their breastfeeding children HEU accessing care at Tygerberg Hospital, in Cape Town, South Africa were enrolled. A powder-based product, potato maltodextrin, was mixed with expressed breast milk and administered to the infants daily for 4 weeks. Data on feasibility, acceptability, adherence, and health outcomes were assessed at the enrollment visit and at the 4 week visit, along with weekly telephone calls. Results 10 mother-infant pairs were enrolled in this study, with infant age ranging from 6-20 months of age. Among the mothers who met the eligibility criteria, all of them enrolled into the study suggesting high acceptability. While there was some Ioss-to-follow-up after the first visit, among the mothers who remained, there were no major feasibility concerns related to study procedures, product administration, adherence, tolerance, and health outcome assessment. Conclusion Our pilot study demonstrated that a powder-based intervention for breastfeeding children HEU in South Africa is acceptable and feasible. This suggests potential feasibility and acceptability for other larger studies, including our ongoing MIGH-T MO study, that use similar powder-based interventions such as probiotics, prebiotics, or synbiotics, in breastfed infants from similar settings.
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Affiliation(s)
| | | | - Mehr Shafiq
- Columbia University Mailman School of Public Health
| | - Elisma Schoeman
- Stellenbosch University Faculty of Medicine and Health Sciences
| | | | - Shaun Barnabas
- Stellenbosch University Faculty of Medicine and Health Sciences
| | - Samantha Fry
- Stellenbosch University Faculty of Medicine and Health Sciences
| | | | - Shuang Wang
- Columbia University Mailman School of Public Health
| | | | - Grace Aldrovandi
- University of California Los Angeles David Geffen School of Medicine
| | | | - Amy L Slogrove
- Stellenbosch University Faculty of Medicine and Health Sciences
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9
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Ibrahim A, Warton FL, Fry S, Cotton MF, Jacobson SW, Jacobson JL, Molteno CD, Little F, van der Kouwe AJW, Laughton B, Meintjes EM, Holmes MJ. Maternal ART throughout gestation prevents caudate volume reductions in neonates who are HIV exposed but uninfected. Front Neurosci 2023; 17:1085589. [PMID: 36968507 PMCID: PMC10035579 DOI: 10.3389/fnins.2023.1085589] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/25/2023] [Indexed: 03/12/2023] Open
Abstract
IntroductionSuccessful programmes for prevention of vertical HIV transmission have reduced the risk of infant HIV infection in South Africa from 8% in 2008 to below 1% in 2018/2019, resulting in an increasing population of children exposed to HIV perinatally but who are uninfected (HEU). However, the long-term effects of HIV and antiretroviral treatment (ART) exposure on the developing brain are not well understood. Whereas children who are HEU perform better than their HIV-infected counterparts, they demonstrate greater neurodevelopmental delay than children who are HIV unexposed and uninfected (HUU), especially in resource-poor settings. Here we investigate subcortical volumetric differences related to HIV and ART exposure in neonates.MethodsWe included 120 infants (59 girls; 79 HEU) born to healthy women with and without HIV infection in Cape Town, South Africa, where HIV sero-prevalence approaches 30%. Of the 79 HEU infants, 40 were exposed to ART throughout gestation (i.e., mothers initiated ART pre conception; HEU-pre), and 39 were exposed to ART for part of gestation (i.e., mothers initiated ART post conception; HEU-post). Post-conception mothers had a mean (± SD) gestational age (GA) of 15.4 (± 5.7) weeks at ART initiation. Mothers with HIV received standard care fixed drug combination ART (Tenofovir/Efavirenz/Emtricitabine). Infants were imaged unsedated on a 3T Skyra (Siemens, Erlangen, Germany) at mean GA equivalent of 41.5 (± 1.0) weeks. Selected regions (caudate, putamen, pallidum, thalamus, cerebellar hemispheres and vermis, and corpus callosum) were manually traced on T1-weighted images using Freeview.ResultsHEU neonates had smaller left putamen volumes than HUU [β (SE) = −90.3 (45.3), p = 0.05] and caudate volume reductions that depended on ART exposure duration in utero. While the HEU-pre group demonstrated no caudate volume reductions compared to HUU, the HEU-post group had smaller caudate volumes bilaterally [β (SE) = −145.5 (45.1), p = 0.002, and −135.7 (49.7), p = 0.008 for left and right caudate, respectively].DiscussionThese findings from the first postnatal month suggest that maternal ART throughout gestation is protective to the caudate nuclei. In contrast, left putamens were smaller across all HEU newborns, despite maternal ART.
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Affiliation(s)
- Abdulmumin Ibrahim
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Fleur L. Warton
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- *Correspondence: Fleur L. Warton,
| | - Samantha Fry
- Department of Paediatrics and Child Health and Tygerberg Children’s Hospital, Faculty of Medicine and Health Sciences, Family Centre for Research with Ubuntu, Stellenbosch University, Stellenbosch, South Africa
| | - Mark F. Cotton
- Department of Paediatrics and Child Health and Tygerberg Children’s Hospital, Faculty of Medicine and Health Sciences, Family Centre for Research with Ubuntu, Stellenbosch University, Stellenbosch, South Africa
| | - Sandra W. Jacobson
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - Joseph L. Jacobson
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - Christopher D. Molteno
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Francesca Little
- Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
| | - Andre J. W. van der Kouwe
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Cape Town, South Africa
- A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States
- Department of Radiology, Harvard Medical School, Boston, MA, United States
| | - Barbara Laughton
- Department of Paediatrics and Child Health and Tygerberg Children’s Hospital, Faculty of Medicine and Health Sciences, Family Centre for Research with Ubuntu, Stellenbosch University, Stellenbosch, South Africa
| | - Ernesta M. Meintjes
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa
- Ernesta M. Meintjes,
| | - Martha J. Holmes
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, Biomedical Engineering Research Centre, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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10
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Nwosu EC, Holmes MJ, Cotton MF, Dobbels E, Little F, Laughton B, van der Kouwe A, Robertson F, Meintjes EM. Similar cortical morphometry trajectories from 5 to 9 years in children with perinatal HIV who started treatment before age 2 years and uninfected controls. BMC Neurosci 2023; 24:15. [PMID: 36829110 PMCID: PMC9951512 DOI: 10.1186/s12868-023-00783-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/14/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Life-long early ART (started before age 2 years), often with periods of treatment interruption, is now the standard of care in pediatric HIV infection. Although cross-sectional studies have investigated HIV-related differences in cortical morphology in the setting of early ART and ART interruption, the long-term impact on cortical developmental trajectories is unclear. This study compares the longitudinal trajectories of cortical thickness and folding (gyrification) from age 5 to 9 years in a subset of children perinatally infected with HIV (CPHIV) from the Children with HIV Early antiRetroviral therapy (CHER) trial to age-matched children without HIV infection. METHODS 75 CHER participants in follow-up care at FAMCRU (Family Centre for Research with Ubuntu), as well as 66 age-matched controls, received magnetic resonance imaging (MRI) on a 3 T Siemens Allegra at ages 5, 7 and/or 9 years. MR images were processed, and cortical surfaces reconstructed using the FreeSurfer longitudinal processing stream. Vertex-wise linear mixed effects (LME) analyses were performed across the whole brain to compare the means and linear rates of change of cortical thickness and gyrification from 5 to 9 years between CPHIV and controls, as well as to examine effects of ART interruption. RESULTS Children without HIV demonstrated generalized cortical thinning from 5 to 9 years, with the rate of thinning varying by region, as well as regional age-related gyrification increases. Overall, the means and developmental trajectories of cortical thickness and gyrification were similar in CPHIV. However, at an uncorrected p < 0.005, 6 regions were identified where the cortex of CPHIV was thicker than in uninfected children, namely bilateral insula, left supramarginal, lateral orbitofrontal and superior temporal, and right medial superior frontal regions. Planned ART interruption did not affect development of cortical morphometry. CONCLUSIONS Although our results suggest that normal development of cortical morphometry between the ages of 5 and 9 years is preserved in CPHIV who started ART early, these findings require further confirmation with longitudinal follow-up through the vulnerable adolescent period.
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Affiliation(s)
- Emmanuel C Nwosu
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa.
| | - Martha J Holmes
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa.,Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Mark F Cotton
- Department of Pediatrics & Child Health, Family Centre for Research With Ubuntu (FAMCRU), Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Els Dobbels
- Department of Pediatrics & Child Health, Family Centre for Research With Ubuntu (FAMCRU), Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Francesca Little
- Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
| | - Barbara Laughton
- Department of Pediatrics & Child Health, Family Centre for Research With Ubuntu (FAMCRU), Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Andre van der Kouwe
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa.,A.A. Martinos Centre for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Frances Robertson
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa.,Neuroscience Institute, University of Cape Town, Cape Town, South Africa.,Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa
| | - Ernesta M Meintjes
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa. .,Neuroscience Institute, University of Cape Town, Cape Town, South Africa. .,Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa.
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11
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Slogrove AL, de Beer ST, Kalk E, Boulle A, Cotton M, Cupido H, Laughton B, Marlow M, Mehta U, Msolo N, Myer L, Powis KM, Schoeman E, Tomlinson M, Zunza M, Williams P, Davies MA. Survival and health of children who are HIV-exposed uninfected: study protocol for the CHERISH (Children HIV-Exposed Uninfected - Research to Inform Survival and Health) dynamic, prospective, maternal-child cohort study. BMJ Open 2023; 13:e070465. [PMID: 36593001 PMCID: PMC9809249 DOI: 10.1136/bmjopen-2022-070465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 12/15/2022] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION CHERISH is designed to establish a long-term sustainable system for measurement of in utero and postnatal exposures and outcomes in children who are HIV-exposed uninfected (HEU) and HIV-unexposed to compare survival, hospitalisation, growth and neurodevelopment in the Western Cape, South Africa. METHODS AND ANALYSIS During 2022-2025, the CHERISH dynamic cohort is prospectively enrolling pregnant people with and without HIV at 24-36 weeks gestation from one urban and one rural community, following mother-child pairs, including children who are HEU (target N=1200) and HIV-unexposed (target N=600) for 3 years from the child's birth. In-person visits occur at enrolment, delivery, 12 months, 24 months and 36 months with intervening 3-monthly telephone data collection. Children and mothers without HIV are tested for HIV at all in-person visits. Data on exposures and outcomes are collected from routine standardised healthcare documentation, maternal interview, measurement (growth and neurodevelopment) at in-person visits and linkage to the Western Cape Provincial Health Data Centre (survival and hospitalisation). A priori adverse birth outcomes, advanced maternal HIV and maternal mental health are considered potential mediators of outcome disparities in children who are HEU and will be evaluated as such in multivariable models appropriate for each outcome. ETHICS AND DISSEMINATION Mothers interested in joining the study are taken through a visual informed consent document for their and their child's participation, with the option to consent to anonymised de-identified data being contributed to a public data repository. All data is captured directly into an electronic database using alphanumeric identifiers devoid of identifying information. The cohort study is approved by Human Research Ethics Committees of Stellenbosch University (N20/08/084), University of Cape Town (723/2021) and Western Cape Government (WC_2021_09_007). Findings will be shared with participants, participating communities, local and provincial stakeholders, child health clinicians, researchers and policymakers at local, national and international forums and submitted for publication in peer-reviewed journals.
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Affiliation(s)
- Amy L Slogrove
- Department of Paediatrics and Child Health, Stellenbosch University Faculty of Medicine and Health Sciences, Worcester, South Africa
- Department of Global Health, Ukwanda Centre for Rural Health, Stellenbosch University Faculty of Medicine and Health Sciences, Worcester, South Africa
| | - Shani Tamlyn de Beer
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town Faculty of Health Sciences, Observatory, South Africa
- Division of Population Health Sciences, University of Bristol, Bristol, UK
| | - Emma Kalk
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town Faculty of Health Sciences, Observatory, South Africa
| | - Andrew Boulle
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town Faculty of Health Sciences, Observatory, South Africa
- Health Intelligence Directorate, Western Cape Provincial Government, Cape Town, South Africa
| | - Mark Cotton
- Department of Paediatrics and Child Health, Family Centre for Research with Ubuntu, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Heinrich Cupido
- Department of Paediatrics and Child Health, Stellenbosch University Faculty of Medicine and Health Sciences, Worcester, South Africa
| | - Barbara Laughton
- Department of Paediatrics and Child Health, Family Centre for Research with Ubuntu, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Marguerite Marlow
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Ushma Mehta
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town Faculty of Health Sciences, Observatory, South Africa
| | - Ncumisa Msolo
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town Faculty of Health Sciences, Observatory, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, University of Cape Town Faculty of Health Sciences, Observatory, South Africa
| | - Kathleen M Powis
- Departments of Internal Medicine and Paediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Elisma Schoeman
- Department of Paediatrics and Child Health, Stellenbosch University Faculty of Medicine and Health Sciences, Worcester, South Africa
| | - Mark Tomlinson
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Moleen Zunza
- Department of Global Health, Division of Epidemiology and Biostatistics, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Paige Williams
- Department of Biostatistics, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town Faculty of Health Sciences, Observatory, South Africa
- Health Intelligence Directorate, Western Cape Provincial Government, Cape Town, South Africa
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12
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Rakshasa-Loots AM, Hamana T, Fanqa B, Lindani F, van Wyhe K, Kruger S, Laughton B. isiXhosa translation of the Patient Health Questionnaire (PHQ-9) shows satisfactory psychometric properties for the measurement of depressive symptoms [Stage 2]. Brain Neurosci Adv 2023; 7:23982128231194452. [PMID: 37667732 PMCID: PMC10475240 DOI: 10.1177/23982128231194452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/25/2023] [Indexed: 09/06/2023] Open
Abstract
Depression is a debilitating illness, and stigma associated with it often prevents people from seeking support. Easy-to-administer and culturally- inclusive tools can allow for early screening for depressive symptoms in primary care clinics, especially in resource-limited settings. In this pre-registered pilot study (Stage 1 Report available at DOI: 10.3389/fpsyt.2022.840912), we produced an open-access isiXhosa-language version of the nine-item Patient Health Questionnaire (PHQ-9), a well-validated measure of depression incidence and severity, using a transcultural translation framework. We validated this isiXhosa PHQ-9 in a sample of N = 47 adolescents living with and without HIV in Cape Town, South Africa who speak isiXhosa at home. Reliability, convergent validity, and criterion validity were assessed, with T scores on the Achenbach System of Empirically Based Assessment Youth Self Report (YSR) form completed previously as reference standard. Our isiXhosa PHQ-9 exhibited satisfactory reliability, with Cronbach's α = 0 . 866 , inter-item correlations ranging from 0.229 to 0.730, and mean item-total correlation of 0.69. PHQ-9 score and Withdrawn/Depressed component T scores on the Youth Self Report were moderately associated (Spearman's ρ = 0 . 40 , p = 0 . 011 ) , indicating acceptable convergent validity. The isiXhosa PHQ-9 showed satisfactory criterion validity (area under the receiver operating characteristic curve, AUC = 0.706), but these analyses were under-powered. Principal component analysis revealed a one-factor solution, with 45.8% of variance explained by the first principal component and all factor loadings above conventional thresholds. Our isiXhosa translation of the PHQ-9 thus exhibited satisfactory psychometric properties in this pilot validation study and performed comparably to other PHQ-9 versions validated in different languages in African and global contexts. This questionnaire may serve as an invaluable culturally-inclusive screening tool for measuring depressive symptoms among isiXhosa speakers. Caution must be exercised as screening tools including the PHQ-9 may over- or under-estimate prevalence of depression. Further validation in larger, independent cohorts may enable wider use of our isiXhosa PHQ-9 as a screening tool in clinics, research studies, and mental health non-profits who serve amaXhosa.
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Affiliation(s)
- Arish Mudra Rakshasa-Loots
- Family Centre for Research with Ubuntu (FAMCRU), Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- Edinburgh Neuroscience, School of Biomedical Sciences, College of Medicine & Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Thandi Hamana
- Family Centre for Research with Ubuntu (FAMCRU), Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- Division of Biomedical Engineering, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Busiswa Fanqa
- Family Centre for Research with Ubuntu (FAMCRU), Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Filicity Lindani
- Family Centre for Research with Ubuntu (FAMCRU), Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Kaylee van Wyhe
- Family Centre for Research with Ubuntu (FAMCRU), Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Sharon Kruger
- Family Centre for Research with Ubuntu (FAMCRU), Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Barbara Laughton
- Family Centre for Research with Ubuntu (FAMCRU), Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
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13
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Shivakoti R, Slogrove AL, Laughton B, Shafiq M, Schoeman E, Glashoff RH, Leu CS, Wang S, Bode L, Aldrovandi G, Kuhn L. Mitigating Infectious morbidity and Growth deficits in HIV-exposed uninfected infanTs with human Milk Oligosaccharide (MIGH-T MO): a randomised trial protocol. BMJ Open 2022; 12:e069116. [PMID: 36585139 PMCID: PMC9809215 DOI: 10.1136/bmjopen-2022-069116] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Children who are HIV-exposed uninfected (HEU), that is, children who do not acquire HIV infection despite being born to mothers with HIV, have a higher risk of mortality, infectious morbidity and growth deficits than children who are HIV-unexposed uninfected (HUU). Prior research has focused on breast feeding and has pointed to changes in human milk oligosaccharides (HMOs) associated with maternal HIV that may influence the infant microbiome and thereby lead to these adverse outcomes. However, to our knowledge, no study has attempted to intervene along this pathway to reduce the occurrence of the adverse outcomes in children HEU. We will conduct a double-blind, randomised trial of a synbiotic intervention, which combines an HMO and probiotic, in breastfed infants HEU in South Africa to evaluate whether this intervention has promise to reduce excess infectious morbidity and growth faltering compared with controls. METHODS AND ANALYSIS One hundred and forty-four breastfed infants HEU, aged 4 weeks, will be 1:1 randomised to receive either a daily synbiotic or an identical-looking placebo through age 24 weeks. Infants will be followed until age 48 weeks and outcomes of infectious morbidity, growth and biological measurements (eg, microbiota, inflammation and metabolome) will be assessed. Analyses will follow intention-to-treat principles comparing the cohorts as randomised. Infants HEU will be compared across arms with respect to the occurrence of infectious morbidity and growth outcomes through 4-24 weeks and 4-48 weeks using appropriate parametric and non-parametric statistical tests. Additionally, an observational cohort of 40 breastfed infants HUU will be recruited as a comparator group with no intervention. ETHICS AND DISSEMINATION Ethical approval for this study has been obtained from the ethics committees at Columbia University and Stellenbosch University. The findings will be disseminated in publications. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT05282485. SANCTR ID number: DOH-27-122021-6543.
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Affiliation(s)
- Rupak Shivakoti
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Amy L Slogrove
- Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
- Ukwanda Centre for Rural Health, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Barbara Laughton
- Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Mehr Shafiq
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Elisma Schoeman
- Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Richard H Glashoff
- Division of Medical Microbiology, Stellenbosch University - Tygerberg Campus, Cape Town, South Africa
| | - Cheng-Shiun Leu
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Shuang Wang
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Lars Bode
- Department of Pediatrics and Mother-Milk-Infant Center of Research Excellence, University of California San Diego, San Diego, California, USA
| | - Grace Aldrovandi
- Department of Pediatrics, University of California Los Angeles, Los Angeles, California, USA
| | - Louise Kuhn
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
- Columbia University Gertrude H Sergievsky Center, New York, New York, USA
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14
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Springer PE, Laughton B, Esterhuizen TM, Slogrove AL, Kruger M. The Molteno Adapted Scale: A child development screening tool for healthcare settings. African Journal of Psychological Assessment 2022. [DOI: 10.4102/ajopa.v4i0.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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15
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Khobo IL, Jankiewicz M, Holmes MJ, Little F, Cotton MF, Laughton B, van der Kouwe AJW, Moreau A, Nwosu E, Meintjes EM, Robertson FC. Multimodal magnetic resonance neuroimaging measures characteristic of early cART-treated pediatric HIV: A feature selection approach. Hum Brain Mapp 2022; 43:4128-4144. [PMID: 35575438 PMCID: PMC9374890 DOI: 10.1002/hbm.25907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 04/03/2022] [Accepted: 04/26/2022] [Indexed: 11/09/2022] Open
Abstract
Children with perinatally acquired HIV (CPHIV) have poor cognitive outcomes despite early combination antiretroviral therapy (cART). While CPHIV-related brain alterations can be investigated separately using proton magnetic resonance spectroscopy (1 H-MRS), structural magnetic resonance imaging (sMRI), diffusion tensor imaging (DTI), and functional MRI (fMRI), a set of multimodal MRI measures characteristic of children on cART has not been previously identified. We used the embedded feature selection of a logistic elastic-net (EN) regularization to select neuroimaging measures that distinguish CPHIV from controls and measured their classification performance via the area under the receiver operating characteristic curve (AUC) using repeated cross validation. We also wished to establish whether combining MRI modalities improved the models. In single modality analysis, sMRI volumes performed best followed by DTI, whereas individual EN models on spectroscopic, gyrification, and cortical thickness measures showed no class discrimination capability. Adding DTI and 1 H-MRS in basal measures to sMRI volumes produced the highest classification performancevalidation accuracy = 85 % AUC = 0.80 . The best multimodal MRI set consisted of 22 DTI and sMRI volume features, which included reduced volumes of the bilateral globus pallidus and amygdala, as well as increased mean diffusivity (MD) and radial diffusivity (RD) in the right corticospinal tract in cART-treated CPHIV. Consistent with previous studies of CPHIV, select subcortical volumes obtained from sMRI provide reasonable discrimination between CPHIV and controls. This may give insight into neuroimaging measures that are relevant in understanding the effects of HIV on the brain, thereby providing a starting point for evaluating their link with cognitive performance in CPHIV.
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Affiliation(s)
- Isaac L. Khobo
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
- Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | - Marcin Jankiewicz
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
- Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
- Cape Universities Body Imaging CenterUniversity of Cape TownCape TownSouth Africa
| | - Martha J. Holmes
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
- Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | - Francesca Little
- Department of Statistical SciencesUniversity of Cape TownCape TownSouth Africa
| | - Mark F. Cotton
- Department of Pediatrics & Child Health, Family Center for Research with Ubuntu, Tygerberg HospitalStellenbosch UniversityCape TownSouth Africa
| | - Barbara Laughton
- Department of Pediatrics & Child Health, Family Center for Research with Ubuntu, Tygerberg HospitalStellenbosch UniversityCape TownSouth Africa
| | - Andre J. W. van der Kouwe
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
- A.A. Martinos Centre for Biomedical ImagingMassachusetts General HospitalBostonMassachusettsUSA
- Department of RadiologyHarvard Medical SchoolBostonMassachusettsUSA
| | | | - Emmanuel Nwosu
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
| | - Ernesta M. Meintjes
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
- Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
- Cape Universities Body Imaging CenterUniversity of Cape TownCape TownSouth Africa
| | - Frances C. Robertson
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
- Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
- Cape Universities Body Imaging CenterUniversity of Cape TownCape TownSouth Africa
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16
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Harden LM, Leahy S, Lala SG, Paul P, Chandna J, Lowick S, Mbatha S, Jaye T, Laughton B, Ghoor A, Sithole P, Msayi J, Kumalo N, Msibi TN, Madhi SA, Lawn JE, Dangor Z. South African Children: A Matched Cohort Study of Neurodevelopmental Impairment in Survivors of Invasive Group B Streptococcus Disease Aged 5 to 8 Years. Clin Infect Dis 2022; 74:S5-S13. [PMID: 34725706 PMCID: PMC8776309 DOI: 10.1093/cid/ciab814] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Invasive group B Streptococcus (iGBS) sepsis and meningitis are important causes of child mortality, but studies on neurodevelopmental impairment (NDI) after iGBS are limited. Using Griffiths Mental Development Scales-Extended Revised (GMDS-ER), we described NDI in iGBS survivors and non-iGBS children from South Africa, as part of a 5-country study. METHODS We identified children aged 5-8 years with a history of iGBS and children with no history of iGBS between October 2019 and January 2021. Children were matched on sex, and birth data (month, year) (matched cohort study). Moderate or Severe NDI was the primary outcome as a composite of GMDS-ER motor, GMDS-ER cognition, hearing, and vision. Secondary outcomes included mild NDI, any emotional-behavioral problems, and GMDS-ER developmental quotients (DQ) calculated by dividing the age equivalent GMDS-ER score by the chronological age. RESULTS In total, 160 children (iGBS survivors, 43; non-iGBS, 117) were assessed. Among iGBS survivors 13 (30.2%) had meningitis, and 30 (69.8%) had sepsis. Six (13.9%) iGBS survivors, and 5 (4.3%) non-iGBS children had moderate or severe NDI. Children who survived iGBS were 5.56 (95% confidence interval [CI]: 1.07-28.93; P = .041) times more likely to have moderate or severe NDI at 5-8 years than non-iGBS children. Compared to the non-iGBS children, iGBS meningitis survivors had a significantly lower global median DQ (P < .05), as well as a lower median DQ for the language GMDS-ER subscale and performance GMDS-ER subscale (P < .05). CONCLUSIONS Children surviving iGBS, particularly meningitis, are more likely to have NDI at 5-8 years compared to non-iGBS children. Further research is required to improve detection and care for at-risk newborns.
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Affiliation(s)
- Lois M Harden
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shannon Leahy
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanjay G Lala
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Proma Paul
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Jaya Chandna
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Lowick
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sibongile Mbatha
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tamara Jaye
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Barbara Laughton
- Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, Western Cape, South Africa
| | - Azra Ghoor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pamela Sithole
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jacqueline Msayi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ntombifuthi Kumalo
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tshepiso N Msibi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ziyaad Dangor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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17
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Fairlie L, Chernoff M, Cotton MF, Bwakura-Dangarembizi M, Violari A, Familiar-Lopez I, Barlow-Mosha L, Kamthunzi P, McCarthy K, Jean-Philippe P, Laughton B, Palumbo PE, Boivin MJ. Antiretroviral choice and severe disease predict poorer neuropsychological outcomes in HIV+ children from Africa. Front Pediatr 2022; 10:899002. [PMID: 35989995 PMCID: PMC9382189 DOI: 10.3389/fped.2022.899002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/13/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The International Maternal Pediatric Adolescent AIDS Clinical Trials Network (IMPAACT) P1104s study evaluated neuropsychological outcomes over 96 weeks in children living with HIV (CLHIV) aged 5-11 years at 6 Sub-Saharan African sites to explore associations between HIV-illness related biomarkers and neuropsychological outcomes. METHODS Children living with HIV had participated in IMPAACT P1060, which compared efficacy of nevirapine versus lopinavir/ritonavir in children initiating ART at <3 years of age. At age 5-11, neuropsychological evaluations of KABC cognitive ability, TOVA attention-impulsivity and BOT-2 motor domains were assessed and repeated after 48 and 96 weeks. Clinical, antiretroviral therapy (ART) and laboratory (immunological and virological) parameters were used to predict neuropsychological outcomes using linear mixed-effects multivariable regression models, controlling for child and caregiver characteristics. RESULTS 246 CLHIV (45% male, mean age at initial neuropsychological evaluation 7.1 yrs [SD 1.2]) began ART at a median age 14.9 months (IQR 8.2, 25.2). Nadir CD4 percentage was 14.7% (IQR 11.0, 19.5); the median peak viral load (VL) was 750 000 copies/ml (IQR 366 000, 750 000) and 63% had ≥WHO stage 3 clinical disease; 164 (67%) were on lopinavir/ritonavir, 71 (29%) were on nevirapine and 7 (3%) were on efavirenz. Other antiretrovirals were similar. Nevirapine at P1104s study start or later was associated with poorer neuropsychological scores across all domains except Global Executive Composite, even when controlling for nadir CD4 percent and time-varying HIV VL. Other predictors of poorer scores in KABC domains included low birth weight, WHO stage 4 disease and serious illness history and elevated VL was associated with worse BOT-2 scores. CONCLUSION Children receiving nevirapine had poorer neuropsychological scores than those on lopinavir/ritonavir. Antiretroviral choice might adversely impact neuropsychological performance. In addition, low birth weight and markers of severe HIV disease: advanced WHO clinical HIV disease, history of serious illness and an elevated VL, were associated with lower neuropsychological scores.
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Affiliation(s)
- Lee Fairlie
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Miriam Chernoff
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Mark F Cotton
- Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Tygerberg, South Africa
| | - Mutsa Bwakura-Dangarembizi
- Harare Family Care CRS, College of Health Sciences Clinical Trials Unit, University of Zimbabwe, Harare, Zimbabwe
| | - Avy Violari
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Itziar Familiar-Lopez
- Department of Psychiatry, Michigan State University, East Lansing, MI, United States
| | - Linda Barlow-Mosha
- Makerere University-Johns Hopkins University Research Collaboration, MU-JHU Care Ltd., CRS, Kampala, Uganda
| | - Portia Kamthunzi
- University of North Carolina Project-Lilongwe, Malawi CRS, Lilongwe, Malawi
| | | | - Patrick Jean-Philippe
- National Institute of Allergy and Infectious Diseases, National Institute of Health, Rockville, MD, United States
| | - Barbara Laughton
- Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Tygerberg, South Africa
| | - Paul E Palumbo
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Michael J Boivin
- Department of Psychiatry, Michigan State University, East Lansing, MI, United States.,Department of Neurology and Ophthalmology, Michigan State University, East Lansing, MI, United States.,Department of Psychiatry, The University of Michigan, Ann Arbor, MI, United States
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18
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Mudra Rakshasa-Loots A, Laughton B. isiXhosa Translation of the Patient Health Questionnaire (PHQ-9): A Pilot Study of Psychometric Properties [Stage 1]. Front Psychiatry 2022; 13:840912. [PMID: 35295783 PMCID: PMC8918580 DOI: 10.3389/fpsyt.2022.840912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/21/2022] [Indexed: 11/15/2022] Open
Abstract
Depression is a debilitating illness, and stigma associated with it often prevents people from seeking support. Easy-to-administer and culturally-specific diagnostic tools can allow for early screening for depression in primary care clinics, especially in resource-limited settings. In this pilot study, we will produce the first open-access isiXhosa-language version of the nine-item Patient Health Questionnaire (PHQ-9), a well-validated measure of depression incidence and severity, using a transcultural translation framework. We will validate this isiXhosa PHQ-9 in a small sample of adolescents living with HIV in Cape Town, South Africa who speak isiXhosa at home. Participants have previously completed the ASEBA Youth Self Report (YSR) form, and responses from the YSR will be used as a gold standard to validate the isiXhosa PHQ-9. If validated through this Registered Report, this isiXhosa PHQ-9 may be an invaluable culturally-specific tool for clinicians serving Xhosa people in identifying clinical or sub-clinical depression.
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Affiliation(s)
- Arish Mudra Rakshasa-Loots
- Edinburgh Neuroscience, School of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, United Kingdom.,Department of Paediatrics and Child Health, Family Centre for Research With Ubuntu (FAMCRU), Stellenbosch University, Cape Town, South Africa
| | - Barbara Laughton
- Department of Paediatrics and Child Health, Family Centre for Research With Ubuntu (FAMCRU), Stellenbosch University, Cape Town, South Africa
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19
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Gie A, Morrison J, Maree D, Laughton B, Browne SH, Cotton MF, Goussard P, Innes S. Childhood lung function following perinatal HIV infection and early antiretroviral therapy initiation: a cross-sectional study. ERJ Open Res 2022; 8:00691-2021. [PMID: 35350281 PMCID: PMC8943286 DOI: 10.1183/23120541.00691-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/02/2022] [Indexed: 11/09/2022] Open
Abstract
Despite the introduction of antiretroviral therapy (ART), HIV-associated pulmonary complications remain prevalent in children following perinatal HIV infection. In the post-ART era the incidence of opportunistic infections has decreased; however, non-infectious complications including diminished lung function are common. It is unclear whether early initiation of ART influences lung function later in life. We performed a cross-sectional study examining pulmonary function tests (PFT) (spirometry, plethysmography, carbon monoxide diffusing capacity) in HIV-unexposed (HU), HIV-exposed-uninfected (HEU) and perinatally HIV-infected children on early ART (HIV+) recruited from the Cape Town arms of the CHER and IMPAACT 1060 trials. PFT was performed once children could participate (October 2013 to January 2020). Global Lung Initiative reference software was used for Z-standardisation of lung function by sex, age and height. In total 394 children (HU n=90, HEU n=162, HIV+ n=142) underwent PFT, median age 8.7 (IQR 7.7-9.8) years. HIV+ had ART initiated at a median age of 17.6 (8.0-36.7) weeks. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC Z-scores were similar in all groups. Plethysmography demonstrated air-trapping with increased total lung capacity (TLC), functional residual capacity, residual volume (RV) and RV/TLC Z-scores in HIV+. There were no differences in alveolar volume; however, diffusing capacity was increased in HIV+. Our findings indicate that following perinatal HIV infection, early ART may attenuate HIV-associated lung disease and is associated with normal childhood spirometry. However plethysmography demonstrates that small airway dysfunction is more pronounced in HIV+. Longitudinal follow-up is required to assess if these children are at risk of obstructive airway disease later in life.
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Affiliation(s)
- Andre Gie
- Dept of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Julie Morrison
- Dept of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - David Maree
- Dept of Medicine, Division of Pulmonology, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Barbara Laughton
- Dept of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
- Family Center for Research with Ubuntu (FAMCRU), Stellenbosch University, Cape Town, South Africa
| | - Sara H. Browne
- Dept of Medicine, University of California San Diego, San Diego, CA, USA
| | - Mark F. Cotton
- Dept of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
- Family Center for Research with Ubuntu (FAMCRU), Stellenbosch University, Cape Town, South Africa
| | - Pierre Goussard
- Dept of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Steve Innes
- Dept of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
- Family Center for Research with Ubuntu (FAMCRU), Stellenbosch University, Cape Town, South Africa
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
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20
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Nöthling J, Laughton B, Seedat S. Maternal depression and infant social withdrawal as predictors of behaviour and development in vertically HIV-infected children at 3.5 years. Paediatr Int Child Health 2021; 41:268-277. [PMID: 35235497 DOI: 10.1080/20469047.2021.2023436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND In low- and middle-income countries, there is a high prevalence of post-partum depression and it is often associated with HIV status. Maternal depression negatively affects mothering and can lead to social withdrawal in infants. Maternal depression and infant social withdrawal can have deleterious long-term effects on children's behaviour and neurodevelopmental trajectories. AIM To investigate whether maternal depression and infant social withdrawal at 10-12 months post-partum were significant predictors of child behaviour and development at 42 months. METHOD Seventy-four mother-infant dyads living with HIV were followed in a prospective, longitudinal design. Mothers were assessed for depression using the Center for Epidemiologic Studies Depression scale (CES-D). Infant social withdrawal was assessed by the modified Alarm Distress Baby Scale (m-ADBB), and development and behaviour were evaluated by the Griffiths Mental Development Scales (GMDS) and the Child Behavior Checklist (CBCL), respectively. RESULTS Maternal depression explained 4.8% of the variance in child behaviour (β = 0.98, t = 2.05, p < 0.05) and 10.3% of the variance in development (β = -0.30, t = -2.66, p < 0.05). Infant social withdrawal was not a significant predictor of behaviour (β = 3.27, t = 1.36, p = 0.18), but it did uniquely explain 7% of the variance in development (β = -1.32, t = -2.48, p < 0.05). CONCLUSION In the context of HIV, screening for maternal depression and the quality of mother-infant interactions are important (especially in the 1st year post-partum), given the significant long-term impact they have on behaviour and neurodevelopment. ABBREVIATIONS ANOVA: analysis of variance; ART: antiretroviral therapy; CBCL: Child Behavioral Checklist; CES-D: Center for Epidemiologic Studies Depression Scale; CHEI: children HIV-exposed and infected; CHER: Children with HIV Early Antiretroviral Treatment Trial; CHEU: children HIV-exposed and uninfected; CHUU: children HIV-unexposed and -uninfected; GMDS: Griffiths Mental Development Scales; HIV: human immunodeficiency virus; LMIC: low- and middle-income countries; m-ADBB: modified Alarm Distress Baby Scale; NRF: National Research Foundation; SAMRC: South African Medical Research Council; WHO: World Health Organization.
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Affiliation(s)
- Jani Nöthling
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Barbara Laughton
- Department of Paediatrics and Child Health, The Family Centre for Research with Ubuntu, Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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21
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Dzikiti M, Laughton B, Innes S, Cotton M. 576Is the method of longitudinal data analysis equally relevant for common versus uncommon endpoints? Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
We explored the effects of predominant breastfeeding on infection-related hospitalization (uncommon outcome), over the first year of life, using the Mother Infant Health cohort study (MIHS), and the effect of early antiretroviral treatment (ART) on viral suppression (< 400 copies/mL) (common outcome), in children aged 7 to 12 weeks, using a subset of the Children with HIV Early AntiRetroviral Treatment (CHER) clinical trial data. We assessed the sensitivity of findings to different models to account for dependency of uncommon and common binary outcome.
Methods
We fitted generalized linear mixed model with (1) random intercept and (2) random slope, generalized estimating equations (GEE) with 3) an exchangeable correlation structure; 4) autoregressive correlation structure of order 1 (AR1) and 5) unstructured correlation structure and 6) logistic regression model.
Results
Eighty four and 119 children from MIHS were non-predominantly and predominantly breastfed, respectively. There were 34 infection-related hospitalizations overall. Most infants were hospitalized once, except for four with two hospitalizations. We analysed 88 HIV-infected children from the CHER trial. On average, a child achieved viral suppression twice, range of one to four. The effect of predominant breastfeeding on infection-related hospitalization was similar across all models, except for the GEE with AR1 that had a high estimate (wider confidence intervals). The effect of early ART exposure on viral suppression varied across models.
Conclusions
The sensitivity of estimates to the method of analysis was driven by frequency of the outcome.
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Affiliation(s)
- Moleen Dzikiti
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Barbara Laughton
- Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Steve Innes
- Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Mark Cotton
- Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
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22
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Madzime J, Cotton MF, Laughton B, van der Kouwe AJW, Meintjes EM, Jankiewicz M. Altered White Matter Tracts in the Somatosensory, Salience, Motor, and Default Mode Networks in 7-Year-Old Children Living with Human Immunodeficiency Virus: A Tractographic Analysis. Brain Connect 2021; 12:302-319. [PMID: 34107770 PMCID: PMC9131360 DOI: 10.1089/brain.2020.0948] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Even with the increased access and early initiation of combination antiretroviral therapy, children with perinatally acquired human immunodeficiency virus (CPHIV) continue to demonstrate white matter alterations. Children perinatally HIV-exposed, but uninfected (CHEU) alike show differences in white matter integrity compared with children who are HIV-unexposed and uninfected (CHUU). Objectives: Mapping white matter connections that link gray matter regions that form resting-state (RS) functional networks may demonstrate whether structural and functional connectivity alterations in HIV infection and exposure may be related. We hypothesized reduced structural connectivity in CPHIV within the default mode network (DMN), visual, ventral DMN (vDMN), somatosensory, salience, auditory, motor, executive, basal ganglia, and posterior DMN (pDMN). We also hypothesized that CHEU will have increased structural connectivity compared with CHUU in the vDMN, somatosensory, pDMN, dorsal attention, salience, auditory, motor and basal ganglia. Methods: Study participants were 61 seven-year-old CPHIV and 46 age-matched children who are HIV uninfected (CHU) (19 CHEU). We used diffusion tensor imaging-based tractography to investigate white matter connections that link gray matter regions within RS functional networks. Results: We found altered white matter integrity in the somatosensory, salience, default mode, and motor networks of CPHIV compared with CHU. The superior temporal cortex, superior frontal cortex, and putamen were affected in all four networks and have also been reported to demonstrate morphological alterations in the same cohort. In CHEU, white matter integrity was higher in the visual network, pDMN, and motor network compared with CHUU. Conclusion: Our results suggest that altered white matter integrity may influence gray matter morphology and functional network alterations. Impact statement The long-term effects of human immunodeficiency virus (HIV) and exposure on the developing brain in the combination antiretroviral therapy era are still not well known. We use diffusion tensor imaging-based tractography to explore these effects on white matter connections that link gray matter regions within functional networks. Our findings provide a context for HIV-associated white matter and connectivity abnormalities.
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Affiliation(s)
- Joanah Madzime
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa.,Neurosciences Institute, University of Cape Town, Cape Town, South Africa
| | - Mark F Cotton
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa.,Neurosciences Institute, University of Cape Town, Cape Town, South Africa
| | - Barbara Laughton
- Family Centre for Research with Ubuntu, Department of Pediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Andre J W van der Kouwe
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Ernesta M Meintjes
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa.,Neurosciences Institute, University of Cape Town, Cape Town, South Africa.,Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa
| | - Marcin Jankiewicz
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa.,Neurosciences Institute, University of Cape Town, Cape Town, South Africa.,Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa
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23
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van Biljon N, Robertson F, Holmes M, Cotton MF, Laughton B, van der Kouwe A, Meintjes E, Little F. Multivariate approach for longitudinal analysis of brain metabolite levels from ages 5-11 years in children with perinatal HIV infection. Neuroimage 2021; 237:118101. [PMID: 33961998 PMCID: PMC8295244 DOI: 10.1016/j.neuroimage.2021.118101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/16/2021] [Accepted: 04/19/2021] [Indexed: 12/03/2022] Open
Abstract
Treatment guidelines recommend that children with perinatal HIV infection (PHIV) initiate antiretroviral therapy (ART) early in life and remain on it lifelong. As part of a longitudinal study examining the long-term consequences of PHIV and early ART on the developing brain, 89 PHIV children and a control group of 85 HIV uninfected children (HIV-) received neuroimaging at ages 5, 7, 9 and 11 years, including single voxel magnetic resonance spectroscopy (MRS) in three brain regions, namely the basal ganglia (BG), midfrontal gray matter (MFGM) and peritrigonal white matter (PWM). We analysed age-related changes in absolute metabolite concentrations using a multivariate approach traditionally applied to ecological data, the Correlated Response Model (CRM) and compared these to results obtained from a multilevel mixed effect modelling (MMEM) approach. Both approaches produce similar outcomes in relation to HIV status and age effects on longitudinal trajectories. Both methods found similar age-related increases in both PHIV and HIV- children in almost all metabolites across regions. We found significantly elevated GPC+PCh across regions (95% CI=[0.033; 0.105] in BG; 95% CI=[0.021; 0.099] in PWM; 95% CI=[0.059; 0.137] in MFGM) and elevated mI in MFGM (95% CI=[0.131; 0.407]) among children living with PHIV compared to HIV- children; additionally the CRM model also indicated elevated mI in BG (95% CI=[0.008; 0.248]). These findings suggest persistent inflammation across the brain in young children living with HIV despite early ART initiation.
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Affiliation(s)
- Noëlle van Biljon
- Department of Statistical Sciences, University of Cape Town, Private Bag X3, Rhodes Gift, 7707 Cape Town, South Africa; Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, South Africa
| | - Frances Robertson
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, South Africa; Cape Universities Body Imaging Centre, Cape Town, South Africa; Neuroscience Institute, University of Cape Town, South Africa
| | - Martha Holmes
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, South Africa; Neuroscience Institute, University of Cape Town, South Africa
| | - Mark F Cotton
- FAMCRU, Department of Paediatrics and Child Health and Tygerberg Children's Hospital, Stellenbosch University, Cape Town, South Africa
| | - Barbara Laughton
- FAMCRU, Department of Paediatrics and Child Health and Tygerberg Children's Hospital, Stellenbosch University, Cape Town, South Africa
| | - Andre van der Kouwe
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, South Africa; Athinoula A. Martinos Center, Massachusetts General Hospital, Charlestown, MA, United States
| | - Ernesta Meintjes
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, South Africa; Cape Universities Body Imaging Centre, Cape Town, South Africa; Neuroscience Institute, University of Cape Town, South Africa
| | - Francesca Little
- Department of Statistical Sciences, University of Cape Town, Private Bag X3, Rhodes Gift, 7707 Cape Town, South Africa.
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24
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Veldsman KA, Laughton B, Janse van Rensburg A, Zuidewind P, Dobbels E, Barnabas S, Fry S, Cotton MF, van Zyl GU. Viral suppression is associated with HIV-antibody level and HIV-1 DNA detectability in early treated children at 2 years of age. AIDS 2021; 35:1247-1252. [PMID: 34076614 PMCID: PMC8186803 DOI: 10.1097/qad.0000000000002861] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Early infant HIV diagnosis and antiretroviral therapy (ART) initiation are now implemented shortly after birth. Maintaining and monitoring ART adherence is difficult and requires frequent visits. We, therefore, investigated whether HIV antibodies and HIV-1 DNA levels are markers of cumulative viremia. DESIGN We conducted a cross sectional investigation at 2 years of age of HIV antibodies and HIV-1 DNA levels in a well characterized cohort of 31 children who started ART shortly after birth. METHODS HIV antibodies were measured by a combination of the Abbott ARCHITECT HIV Ag/Ab Combo and Geenius HIV 1/2 supplemental assays; and total HIV-1 DNA quantified using a sensitive quantitative PCR (qPCR) assay targeting the HIV-1 integrase gene. RESULTS Infant post-exposure prophylaxis consisted of zidovudine (AZT) and nevirapine (NPV) (or NVP only, in one child) within 1 day of birth, transitioning, after positive diagnosis, to three-drug ART, at a median [interquartile range (IQR)] of 7 (4-9.5) days. Twelve of 31 children had well suppressed HIV plasma viral loads (HIVVL) and the remainder periods of viremia (HIVVL > 100 copies/ml after 3 months of ART), classified as non-suppressed. At 24 months of age: 11 of 12 (92%) of well suppressed children had undetectable HIV-1 antibodies versus 3 of 19 (16%) non-suppressed children (P < 0.001) and 7 of 12 (58%) well suppressed children had undetectable HIV-1 DNA versus 3 of 19 (16%) non-suppressed children (P = 0.02). CONCLUSION Considering low assay costs and the high proportion of well suppressed children with undetected antibody levels at 2 years, HIV antibody levels may be a valuable marker of cumulative adherence in children who start treatment shortly after birth and could prompt adherence and viral load investigation.
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Affiliation(s)
- Kirsten A Veldsman
- Division of Medical Virology, Stellenbosch University, Faculty of Medicine and Health Sciences
- National Health Laboratory Service, Tygerberg Business Unit
| | - Barbara Laughton
- Department Paediatrics and Child Health, Stellenbosch University and Tygerberg Children's Hospital, Cape Town, South Africa
| | - Anita Janse van Rensburg
- Department Paediatrics and Child Health, Stellenbosch University and Tygerberg Children's Hospital, Cape Town, South Africa
| | - Peter Zuidewind
- Department Paediatrics and Child Health, Stellenbosch University and Tygerberg Children's Hospital, Cape Town, South Africa
| | - Els Dobbels
- Department Paediatrics and Child Health, Stellenbosch University and Tygerberg Children's Hospital, Cape Town, South Africa
| | - Shaun Barnabas
- Department Paediatrics and Child Health, Stellenbosch University and Tygerberg Children's Hospital, Cape Town, South Africa
| | - Samantha Fry
- Department Paediatrics and Child Health, Stellenbosch University and Tygerberg Children's Hospital, Cape Town, South Africa
| | - Mark F Cotton
- Department Paediatrics and Child Health, Stellenbosch University and Tygerberg Children's Hospital, Cape Town, South Africa
| | - Gert U van Zyl
- Division of Medical Virology, Stellenbosch University, Faculty of Medicine and Health Sciences
- National Health Laboratory Service, Tygerberg Business Unit
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25
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van Wyhe KS, Laughton B, Cotton MF, Meintjes EM, van der Kouwe AJW, Boivin MJ, Kidd M, Thomas KGF. Cognitive outcomes at ages seven and nine years in South African children from the children with HIV early antiretroviral (CHER) trial: a longitudinal investigation. J Int AIDS Soc 2021; 24:e25734. [PMID: 34259393 PMCID: PMC8278859 DOI: 10.1002/jia2.25734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/13/2021] [Accepted: 04/22/2021] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Many children living with HIV (CLWH) display impaired cognition. Although early combination antiretroviral therapy (ART) produces improved cognitive outcomes, more long-term outcome data are needed. After concluding the Children with HIV Early antiRetroviral (CHER) trial in 2011, we investigated cognitive performance, at seven and nine years of age. Participants had been randomized to deferred ART (ART-Def; n = 22); immediate time-limited ART for 40 weeks (ART-40W; n = 30) and immediate time-limited ART for 96 weeks (ART-96W; n = 18). We also recruited HIV-exposed uninfected (CHEU; n = 28) and HIV-unexposed (CHU; n = 35) children. METHODS Data were collected between May 2012 and December 2017. Mixed-model repeated-measures ANOVAs assessed differences over time between CLWH (ART-40W, ART-96W and ART-Def) and CHIV- CHEU and CHU between ART-Early (ART-40W and ART-96W), ART-Def, CHEU and CHU; and between ART-40W, ART-96W, ART-Def, CHEU and CHU. RESULTS All comparisons found significant effects of Time for most outcome variables (better scores at nine than at seven years; ps < 0.05). The first ANOVAs found that for (a) motor dexterity, CLWH performed worse than CHIV- at seven years (p < 0.001) but improved to equivalence at nine years, (b) visual-spatial processing and problem solving, only CLWH (p < 0.04) showed significant performance improvement over time and (c) working memory and executive function, CLWH performed worse than CHIV- at both seven and nine years (p = 0.03 and 0.04). The second ANOVAs found that for (a) working memory, CHU performed better than ART-Early and CHEU (p < 0.01 and <0.04), and (b) motor dexterity, ART-Def performed worse than ART-Early, CHEU and CHU at seven years (p = 0.02, <0.001 and <0.001 respectively) but improved to equivalence at nine years (ps > 0.17). Similarly, for motor dexterity, ART-Def performed worse than ART-96W, CHEU and CHU at seven years (p < 0.04, <0.001 and <0.001) but improved to equivalence at nine years (ps > 0.20). CONCLUSIONS Although neurocognitive developmental trajectories for treatment groups and controls were largely similar (i.e. performance improvements from 7 to 9), all ART-treated children, regardless of treatment arm, remain at risk for cognitive deficits over early school ages. Although the nature of these deficits may change as cognitive development proceeds, there are potential negative consequences for these children's future learning, reasoning and adaptive functioning.
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Affiliation(s)
- Kaylee S van Wyhe
- ACSENT LaboratoryDepartment of PsychologyUniversity of Cape TownCape TownSouth Africa
- Family Centre for Research with UbuntuDepartment of Paediatrics and Child HealthFaculty of Medicine and Health Sciences Stellenbosch UniversityCape TownSouth Africa
| | - Barbara Laughton
- Family Centre for Research with UbuntuDepartment of Paediatrics and Child HealthFaculty of Medicine and Health Sciences Stellenbosch UniversityCape TownSouth Africa
| | - Mark F Cotton
- Family Centre for Research with UbuntuDepartment of Paediatrics and Child HealthFaculty of Medicine and Health Sciences Stellenbosch UniversityCape TownSouth Africa
| | - Ernesta M Meintjes
- Biomedical Engineering Research CentreDivision of Biomedical EngineeringDepartment of Human BiologyUniversity of Cape TownSouth Africa
| | - Andre JW van der Kouwe
- Athinoula A. Martinos Center for Biomedical ImagingMassachusetts General HospitalCharlestownMAUSA
| | - Michael J Boivin
- Department of Psychiatry and Neurology and OphthalmologyMichigan State UniversityEast LansingMIUSA
- Department of PsychiatryUniversity of MichiganAnn ArborMIUSA
| | - Martin Kidd
- Centre of Statistical ConsultationStellenbosch UniversityCape TownSouth Africa
| | - Kevin GF Thomas
- ACSENT LaboratoryDepartment of PsychologyUniversity of Cape TownCape TownSouth Africa
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26
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Nwosu EC, Holmes MJ, Cotton MF, Dobbels E, Little F, Laughton B, van der Kouwe A, Meintjes EM, Robertson F. Cortical structural changes related to early antiretroviral therapy (ART) interruption in perinatally HIV-infected children at 5 years of age. IBRO Neurosci Rep 2021; 10:161-170. [PMID: 34179869 PMCID: PMC8211921 DOI: 10.1016/j.ibneur.2021.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/03/2021] [Indexed: 12/21/2022] Open
Abstract
ART interruption in children can occur especially in resource-limited settings for reasons including poor adherence, stock-outs, ART intolerance of non-pediatric formulas and pill size, as well as ultimately to test for HIV remission. Although early ART initiation is now standard of care in pediatric HIV management, very little is known on the effect of early ART initiation or subsequent interruption on brain development. This study aimed to investigate the effect of ART interruption on brain cortical thickness (CT) and folding in a subset of children from the Children with HIV Early antiRetroviral therapy (CHER) trial cohort who all started ART before 18 months of age. CHER participants in the neuroimaging follow-up study had magnetic resonance (MRI) scans on a 3T Siemens Allegra brain scanner at age 5.44 ± 0.37 years. MR images were processed using the automated cross-sectional stream in FreeSurfer v6.0 and vertex wise comparisons of CT and local gyrification indices (LGIs) were performed between HIV+ children and HIV- controls, as well as between HIV+ children on interrupted or continuous ART and controls. HIV+ children (n = 46) showed thicker cortex than HIV- children (n = 29) in bilateral frontal and left temporo-insular regions but lower LGIs in left superior and bilateral medial orbitofrontal cortex extending into rostral anterior cingulate. Children on interrupted ART (n = 21) had thicker cortex than HIV- controls in left frontal and right insular regions, but children on continuous treatment (n = 25) showed no difference from controls. Children on both interrupted and continuous ART showed region-specific alterations in LGI relative to controls. Cortical folding appears more sensitive than CT to early life events including early ART and interruption. However, immune health resilience in children can translate to long term preservation of morphometric brain development, especially for those on early and continuous treatment.
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Affiliation(s)
- Emmanuel C. Nwosu
- UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa
- Neuroscience Institute, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Martha J. Holmes
- UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa
- Neuroscience Institute, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Mark F. Cotton
- Family Centre for Research with Ubuntu, Department of Paediatrics & Child Health, Tygerberg Children’s Hospital and Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Els Dobbels
- Family Centre for Research with Ubuntu, Department of Paediatrics & Child Health, Tygerberg Children’s Hospital and Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Francesca Little
- Department of Statistical Sciences, Faculty of Sciences, University of Cape Town, South Africa
| | - Barbara Laughton
- Family Centre for Research with Ubuntu, Department of Paediatrics & Child Health, Tygerberg Children’s Hospital and Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Andre van der Kouwe
- A.A. Martinos Centre for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Ernesta M. Meintjes
- UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa
- Neuroscience Institute, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Frances Robertson
- UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa
- Neuroscience Institute, Faculty of Health Sciences, University of Cape Town, South Africa
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27
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Boivin MJ, Chernoff M, Fairlie L, Laughton B, Zimmer B, Joyce C, Barlow-Mosha L, Bwakura-Dangarembizi M, Vhembo T, Ratswana M, Kamthunzi P, McCarthy K, Familiar-Lopez I, Jean-Philippe P, Coetzee J, Abrahams N, Gous H, Violari A, Cotton MF, Palumbo PE. African Multi-Site 2-Year Neuropsychological Study of School-Age Children Perinatally Infected, Exposed, and Unexposed to Human Immunodeficiency Virus. Clin Infect Dis 2021; 71:e105-e114. [PMID: 31848582 DOI: 10.1093/cid/ciz1088] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/31/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Children living with human immunodeficiency virus (HIV) are at neuropsychological risk for cognitive and motor dysfunction. However, few prospective, multi-site studies have evaluated neuropsychological outcomes longitudinally among perinatally infected African children who received early antiretroviral treatment (ART). METHODS We enrolled 611 children aged 5 to 11 years at 6 sites (South Africa [3], Zimbabwe, Malawi, Uganda). Of these, there were 246 children living with HIV (HIV+) who were initiated on ART before 3 years of age in a prior clinical trial comparing nevirapine to lopinavir/ritonavir (International Maternal Pediatric Adolescent Acquired Immunodeficiency Syndrome Clinical Trials [IMPAACT] P1060); 183 age-matched, exposed but uninfected (HEU) children; and 182 unexposed and uninfected (HUU) children. They were compared across 3 assessment time points (Weeks 0, 48, and 96) on cognitive ability (Kaufman Assessment Battery for Children, second edition [KABC-II]), attention/impulsivity (Tests of Variables of Attention [TOVA]), motor proficiency (Bruininks-Oseretsky Test, second edition [BOT-2]), and on the Behavior Rating Inventory of Executive Function (BRIEF). The cohorts were compared using linear mixed models, adjusting for site, child's age and sex, and selected personal/family control variables. RESULTS The HIV+ cohort performed significantly worse than the HEU and HUU cohorts for all KABC-II, TOVA, and BOT-2 performance outcomes across all 3 time points (P values < .001). The HUU and HEU cohorts were comparable. For the KABC-II planning/reasoning subtests, the HIV+ children showed less improvement over time than the HUU and HEU groups. The groups did not differ significantly on the BRIEF. CONCLUSIONS Despite initiation of ART in early childhood and good viral suppression at the time of enrollment, the HIV+ group had poorer neuropsychological performance over time, with the gap progressively worsening in planning/reasoning. This can be debilitating for self-management in adolescence.
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Affiliation(s)
- Michael J Boivin
- Department of Psychiatry, Michigan State University, East Lansing, Michigan, USA.,Department of Neurology and Ophthalmology, Michigan State University, East Lansing, Michigan, USA.,Department of Psychiatry, the University of Michigan, Ann Arbor, Michigan, USA
| | - Miriam Chernoff
- Center for Biostatistics in Acquired Immunodeficiency Syndrome Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Lee Fairlie
- Wits Reproductive Health and Human Immunodeficiency Virus Research Centre, Shandukani Clinic, Johannesburg, South Africa
| | - Barbara Laughton
- Family Centre for Research with UBUNTU, Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | | | - Celeste Joyce
- Perinatal Human Immunodeficiency Virus Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Linda Barlow-Mosha
- Makerere University-Johns Hopkins University Research Collaboration CRS, Kampala, Uganda
| | | | - Tichaona Vhembo
- Harare Family Care CRS, University of Zimbabwe, College of Health Sciences Clinical Trials Unit, Harare, Zimbabwe
| | - Mmule Ratswana
- Wits Reproductive Health and Human Immunodeficiency Virus Research Centre, Shandukani Clinic, Johannesburg, South Africa
| | - Portia Kamthunzi
- University of North Carolina Project-Lilongwe, Malawi CRS, Lilongwe, Malawi
| | - Katie McCarthy
- Clinical Research Management, FHI360, Durham, North Carolina, USA
| | | | - Patrick Jean-Philippe
- National Institute of Allergy and Infectious Diseases, National Institute of Health, Rockville, Maryland, USA
| | - Joan Coetzee
- Family Centre for Research with UBUNTU, Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Nasreen Abrahams
- Perinatal Human Immunodeficiency Virus Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Hermien Gous
- Wits Reproductive Health and Human Immunodeficiency Virus Research Centre, Shandukani Clinic, Johannesburg, South Africa
| | - Avy Violari
- Perinatal Human Immunodeficiency Virus Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark F Cotton
- Family Centre for Research with UBUNTU, Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Paul E Palumbo
- Hitchcock Medical School of Dartmouth University, New Lebanon, New Hampshire, USA
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28
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Innes S, Laughton B, van Toorn R, Otwombe K, Liberty A, Dobbels E, Violari A, Kruger M, Cotton MF. Recovery of HIV encephalopathy in perinatally infected children on antiretroviral therapy. Dev Med Child Neurol 2020; 62:1309-1316. [PMID: 32779195 DOI: 10.1111/dmcn.14639] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2020] [Indexed: 12/14/2022]
Abstract
AIM To describe the trajectory of clinical signs in children who developed human immunodeficiency virus encephalopathy (HIVE) after starting early antiretroviral therapy (ART). METHOD This was a retrospective case-cohort description of HIVE among Cape Town participants from the Children with HIV Early AntiRetroviral treatment (CHER) trial. Criteria for HIVE diagnosis were at least two of: (1) acquired central motor deficit, (2) impaired brain growth, and (3) failure to attain or loss of developmental milestones in the absence of an alternative aetiology. RESULTS Of 133 surviving participants who initiated ART at a median age of 9 weeks and who were followed until a median age of 6 years, 20 (12%) developed HIVE at a median age 31 months (interquartile range 19-37). In these, the first neurological deterioration was noticed at a median age of 19 months, when 16 were on ART and nine had undetectable HIV viral load for a median of 12 months. Signs of upper motor neurons were present in 18, of whom 12 resolved and four had persistent spastic diplegia; 19 had motor delay, of whom 14 resolved; 12 had language delay, of whom 11 resolved; and 16 had impaired brain growth, of whom only five recovered. For the 16 participants already on ART at HIVE diagnosis, regimens were not altered in response to diagnosis. INTERPRETATION HIVE may occur despite early ART initiation and virological suppression and then resolve on unchanged ART, most likely as intrathecal inflammation subsides. WHAT THIS PAPER ADDS Despite suppressive antiretroviral therapy, children can develop human immunodeficiency virus encephalopathy, The most common manifestations are motor deficits and impaired brain growth. Most experience improvement, with many resolving without additional intervention.
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Affiliation(s)
- Steve Innes
- Family Center for Research with Ubuntu (FAMCRU), Stellenbosch University, Cape Town, South Africa.,Department of Paediatrics and Child Health, Tygerberg Children's Hospital, Cape Town, South Africa
| | - Barbara Laughton
- Family Center for Research with Ubuntu (FAMCRU), Stellenbosch University, Cape Town, South Africa.,Department of Paediatrics and Child Health, Tygerberg Children's Hospital, Cape Town, South Africa
| | - Ronald van Toorn
- Department of Paediatrics and Child Health, Tygerberg Children's Hospital, Cape Town, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Afaaf Liberty
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Els Dobbels
- Family Center for Research with Ubuntu (FAMCRU), Stellenbosch University, Cape Town, South Africa
| | - Avy Violari
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Mariana Kruger
- Department of Paediatrics and Child Health, Tygerberg Children's Hospital, Cape Town, South Africa
| | - Mark F Cotton
- Family Center for Research with Ubuntu (FAMCRU), Stellenbosch University, Cape Town, South Africa.,Department of Paediatrics and Child Health, Tygerberg Children's Hospital, Cape Town, South Africa
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29
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Ackermann C, Andronikou S, Saleh MG, Kidd M, Cotton MF, Meintjes EM, Laughton B. Diffusion tensor imaging point to ongoing functional impairment in HIV-infected children at age 5, undetectable using standard neurodevelopmental assessments. AIDS Res Ther 2020; 17:20. [PMID: 32430069 PMCID: PMC7236356 DOI: 10.1186/s12981-020-00278-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/08/2020] [Indexed: 11/30/2022] Open
Abstract
Background Perinatal HIV infection negatively impacts cognitive functioning of children, main domains affected are working memory, processing speed and executive function. Early ART, even when interrupted, improves neurodevelopmental outcomes. Diffusion tension imaging (DTI) is a sensitive tool assessing white matter damage. We hypothesised that white matter measures in regions showing HIV-related alterations will be associated with lower neurodevelopmental scores in specific domains related to the functionality of the affected tracts. Methods DTI was performed on children in a neurodevelopmental sub study from the Children with HIV Early Antiretroviral (CHER) trial. Voxel-based group comparisons to determine regions where fractional anisotropy and mean diffusion differed between HIV+ and uninfected children were done. Locations of clusters showing group differences were identified using the Harvard–Oxford cortical and subcortical and John Hopkins University WM tractography atlases provided in FSL. This is a second review of DTI data in this cohort, which was reported in a previous study. Neurodevelopmental assessments including GMDS and Beery-Buktenica tests were performed and correlated with DTI parameters in abnormal white matter. Results 38 HIV+ children (14 male, mean age 64.7 months) and 11 controls (4 male, mean age 67.7 months) were imaged. Two clusters with lower fractional anisotropy and 7 clusters with increased mean diffusion were identified in the HIV+ group. The only neurodevelopmental domain with a trend of difference between the HIV+ children and controls (p = 0.08), was Personal Social Quotient which correlated to improved myelination of the forceps minor in the control group. As a combined group there was a negative correlation between visual perception and radial diffusion in the right superior longitudinal fasciculus and left inferior longitudinal fasciculus, which may be related to the fact that these tracts, forming part of the visual perception pathway, are at a crucial state of development at age 5. Conclusion Even directed neurodevelopmental tests will underestimate the degree of microstructural white matter damage detected by DTI. The visual perception deficit detected in the entire study population should be further examined in a larger study.
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30
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Veldsman KA, Janse van Rensburg A, Isaacs S, Naidoo S, Laughton B, Lombard C, Cotton MF, Mellors JW, van Zyl GU. HIV-1 DNA decay is faster in children who initiate ART shortly after birth than later. J Int AIDS Soc 2020; 22:e25368. [PMID: 31441231 PMCID: PMC6868516 DOI: 10.1002/jia2.25368] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 07/15/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction There is limited data in children on whether persistence of HIV‐1 infected cells is affected by age at initiating antiretroviral therapy (ART), its duration or any subsequent ART interruption. We therefore investigated the effects of both age of ART initiation and duration of ART interruption on HIV‐1 DNA decay in children. Methods We investigated HIV‐1 DNA decay in three groups of children on ART: Group‐1 (n = 7) started uninterrupted ART within eight days of life; Group‐2 (n = 8) started uninterrupted ART at a median of five months of age; and Group‐3 (n = 23) started ART at a median age of 1.8 months for either 40 or 96 weeks, then interrupted ART (median of seven months), and restarted ART based on CD4 count and clinical criteria. Total HIV‐1 DNA was assayed using a sensitive HIV‐1 subtype C‐adapted quantitative PCR for integrase. The duration of ART was square root transformed to fit the observed slowing of HIV‐1 DNA decay rate. For each group, point estimates for decay rates were determined after six months of continuous suppressive ART in groups 1 and 2 or six months after restarting ART in Group‐3. Groups‐2 and 3 were combined using a mixed effect regression model to investigate covariates of HIV‐1 DNA decay rate. Results and Discussion At six months of continuous suppressive ART, the HIV‐1 DNA t½ (95% CI) was shorter in Group‐1 (n = 7): 2.7 months (2.1 to 3.8), than 9.2 months (7.4 to 12.1) in Group‐2 (n = 8); and 9.6 months (7.6 to 12.6) in Group‐3 (n = 23) (p < 0.01). In multivariable analyses, HIV‐1 DNA before treatment (p < 0.001) and the change in HIV‐1 DNA during interruption (p < 0.01) were independent predictors of slower HIV‐1 DNA decay. Conclusions These data suggest that ART initiation within the first week of life can reduce the persistence of long‐lived infected cells. Delaying ART is associated with slower decay of infected cells.
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Affiliation(s)
- Kirsten A Veldsman
- Division of Medical Virology, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Anita Janse van Rensburg
- Department Pediatrics and Child Health, Tygerberg Children's Hospital and Family Clinical Research Unit, Stellenbosch University, Cape Town, South Africa
| | - Shahieda Isaacs
- Division of Medical Virology, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Shalena Naidoo
- Division of Medical Virology, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Barbara Laughton
- Department Pediatrics and Child Health, Tygerberg Children's Hospital and Family Clinical Research Unit, Stellenbosch University, Cape Town, South Africa
| | - Carl Lombard
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Mark F Cotton
- Department Pediatrics and Child Health, Tygerberg Children's Hospital and Family Clinical Research Unit, Stellenbosch University, Cape Town, South Africa
| | - John W Mellors
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gert U van Zyl
- Division of Medical Virology, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa.,National Health Laboratory Service, Cape Town, South Africa
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Laughton B, Naidoo S, Dobbels EF, Boivin MJ, van Rensburg AJ, Glashoff RH, van Zyl GU, Kruger M, Cotton MF. Neurodevelopment at 11 months after starting antiretroviral therapy within 3 weeks of life. South Afr J HIV Med 2019; 20:1008. [PMID: 31745434 PMCID: PMC6852492 DOI: 10.4102/sajhivmed.v20i1.1008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/18/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) started between 7 and 12 weeks of age improves neurodevelopmental outcomes in HIV-infected (HIV+) infants, but the impact of even earlier initiation is not yet described. OBJECTIVES We assessed the early neurodevelopment of HIV+ infants who started ART within 21 days of life. METHOD Participants were enrolled from the public sector birth HIV-diagnosis programme. Inclusion criteria included the following: birth weight > 2000 g, infant commencing ART < 6 weeks and no infant cytomegalovirus disease. Antiretroviral therapy included Zidovudine/Lamivudine/Nevirapine for the first 2 weeks, the latter then replaced by Lopinavir/Ritonavir. Once body weight > 3 kg and gestational age > 44 weeks, Abacavir replaced Zidovudine. The Griffiths mental development scales (GMDS) were administered at 10-12 months. RESULTS Of 29 infants assessed, 23 (79%) were girls. Mean birth weight was 3002 ± 501 g. Twenty-four mothers (83%) received ART during pregnancy. Seven (24%) infants were diagnosed HIV+ within 48 h of birth. Median [interquartile range] viral load (VL) at diagnosis was 3904 [259-16 922] copies/mL, age starting ART was 6.0 [3-10] days and age at VL suppression was 19.1 [15-36] weeks. At the GMDS assessment, nine (31%) participants had detectable VL and 26 (90%) had World Health Organization (WHO) clinical stage I disease. The GMDS was performed at a mean age of 11.5 ± 0.8 months. Mean quotients were within the average range: Global Griffiths score was 103.6 ± 10.9 and mean quotients on the subscales ranged from lowest 95.9 ± 13.4 for locomotor to highest 112.8 ± 11.3 for hearing-and-language. CONCLUSION Preliminary findings in this small group suggest that early neurodevelopmental scores are within the normal range in infants with perinatal HIV infection who started ART at a median of 6 days.
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Affiliation(s)
- Barbara Laughton
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Shalena Naidoo
- Department of Pathology, Stellenbosch University, Cape Town, South Africa
| | - Els F.M.T. Dobbels
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Michael J. Boivin
- Department of Psychiatry, Michigan State University, East Lansing, United States
- Department of Neurology and Ophthalmology, Michigan State University, East Lansing, United States
| | | | - Richard H. Glashoff
- Department of Pathology, Stellenbosch University, Cape Town, South Africa
- National Laboratory Services, Cape Town, South Africa
| | - Gert U. van Zyl
- National Laboratory Services, Cape Town, South Africa
- Division of Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Mariana Kruger
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Mark F. Cotton
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
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Familiar I, Chernoff M, Ruisenor-Escudero H, Laughton B, Joyce C, Fairlie L, Vhembo T, Kamthunzi P, Barlow-Barlow L, Zimmer B, McCarthy K, Boivin MJ. Association between caregiver depression symptoms and child executive functioning. Results from an observational study carried out in four sub-Saharan countries. AIDS Care 2019; 32:486-494. [PMID: 31462095 DOI: 10.1080/09540121.2019.1659917] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Depressive symptoms among HIV-positive (HIV+) women may negatively impact their health and possibly that of their young children through risk of compromised caregiving. We evaluated how depression symptoms in predominantly (97%) female caregivers relate to neurodevelopmental outcomes in their HIV affected children. Data come from the IMPAACT P1104s Study, an observational cohort across six sites in four countries: Zimbabwe, South Africa, Uganda and Malawi. Participants (n = 611) were 5-11-year-old children with HIV (HIV), HIV exposed uninfected (HEU), or HIV unexposed uninfected (HUU). Primary caregivers were assessed for depression with the Hopkins Symptom Checklist (HSCL) and children with Behavior Rating Inventory for Executive Function (BRIEF) parent-report, Kauffman Assessment Battery for Children II (KABC), Bruininks-Oseretsky Test of Motor Proficiency 2nd Ed. (BOT-2), Test of Variables of Attention (TOVA), Multiple Indicators Cluster Survey, Child Disability and Development scales (MICS-4). Caregivers with higher depression scores (>1.75 mean HSCL score) reported more executive function problems in their children, regardless of HIV status. All executive function scores were significantly (p < 0.001) associated with depressive symptomatology at baseline and across time. Caregiver depressive symptomatology was not associated with other assessed neurocognitive outcomes. These results highlight the potential impact of caregiver depression on child behavioral outcomes.
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Affiliation(s)
- Itziar Familiar
- Department of Psychiatry, Michigan State University, East Lansing, MI, USA
| | - Miriam Chernoff
- Center for Biostatistics in AIDS Research, Harvard University, Boston, MA, USA
| | | | - Barbara Laughton
- Department of Pediatrics and Child Health, Stellenboch University, Tygerberg, RSA
| | - Celeste Joyce
- Perinatal HIV Research Unit (PHRU), Chris Hani Baragwanath Hospital, Johannesburg, RSA
| | - Lee Fairlie
- Wits Reproductive Health and HIV Institute, Shandukani Clinic, Johannesburg, RSA
| | - Tichaona Vhembo
- Harare Family Care CRS, University of Zimbabwe, Harare, Zimbabwe
| | - Portia Kamthunzi
- University of North Carolina-Lilongwe Clinical Research Institute, Lilongwe, Malawi
| | - Linda Barlow-Barlow
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | | | - Michael J Boivin
- Departments of Psychiatry and Neurology, Michigan State University, East Lansing, MI, USA
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Springer PE, Kalk E, Pretorius C, Chirehwa MT, Kruger M, Cotton MF, Laughton B. Value of the Goodenough Drawing Test as a research tool to detect developmental delay in South African preschool children. South African Journal of Psychology 2019. [DOI: 10.1177/0081246319850683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is a need for simple, cost-effective research tools to detect developmental delay in preschool children in low- and middle-income countries where insufficient resources are often a barrier to detection and management. The Goodenough Draw-a-Person test is freely available, easily administered, and requires limited language ability and equipment; it is thus potentially useful in resource-constrained settings. We aimed to determine the diagnostic accuracy of the Draw-a-Person test to identify developmental delay in 5-year-old preschool children using the Griffiths Mental Developmental Scales-Extended Revised eye-hand coordination subquotient as the gold standard. This was a cross-sectional analysis of drawings by South African preschool children from low-income families, whose Griffiths Mental Developmental Scales-Extended Revised assessments included a human figure drawing. Draw-a-Person test quotients were estimated independently by a developmental paediatrician and two medical officers to calculate inter-rater agreement. The paediatrician’s scores were used to determine the diagnostic accuracy of the Draw-a-Person test quotient (<85) to predict developmental delay with the eye-hand coordination subquotient (<75). A total of 125 children were included, with a mean age of 60.8 months (range 59–66 months) of which 48.8% were boys. The mean Draw-a-Person test score was 94 (standard deviation 15) with 28 Draw-a-Person test scores below 85. Applying the Draw-a-Person test cut-off of 85, sensitivity of the Draw-a-Person test to the eye-hand coordination subquotient was 80% and specificity 89%. The area under the receiver operator characteristic curve was 0.87 (95% confidence interval [0.78–0.96]). The Goodenough Draw-a-Person test could thus be a useful research tool for detecting fine motor and visuoperceptual delay in South African preschool children.
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Affiliation(s)
- Priscilla Estelle Springer
- Department of Paediatrics and Child Health and Tygerberg Children’s Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University
| | - Emma Kalk
- Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, South Africa
| | | | - Maxwell Tawanda Chirehwa
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Mariana Kruger
- Department of Paediatrics and Child Health and Tygerberg Children’s Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University
| | - Mark Frederic Cotton
- Department of Paediatrics and Child Health and Tygerberg Children’s Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University
- Family Clinical Research Unit and Tygerberg Hospital,Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Barbara Laughton
- Department of Paediatrics and Child Health and Tygerberg Children’s Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University
- Family Clinical Research Unit and Tygerberg Hospital,Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
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Laughton B, Cornell M, Kidd M, Springer PE, Dobbels EFMT, Rensburg AJV, Otwombe K, Babiker A, Gibb DM, Violari A, Kruger M, Cotton MF. Five year neurodevelopment outcomes of perinatally HIV-infected children on early limited or deferred continuous antiretroviral therapy. J Int AIDS Soc 2019; 21:e25106. [PMID: 29722482 PMCID: PMC5932637 DOI: 10.1002/jia2.25106] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 03/08/2018] [Indexed: 11/08/2022] Open
Abstract
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, HIV-infected 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 HIV-infected children scored lower. Poorer visual perception performance warrants further investigation.
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Affiliation(s)
- Barbara Laughton
- Family Clinical Research Unit, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology and Research, and Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Martin Kidd
- Centre for Statistical Consultation, Department of Statistics and Actuarial Sciences, University of Stellenbosch, Matieland, South Africa
| | - Priscilla Estelle Springer
- Family Clinical Research Unit, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Els Françoise Marie-Thérèse Dobbels
- Family Clinical Research Unit, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Anita Janse Van Rensburg
- Family Clinical Research Unit, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Abdel Babiker
- Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom
| | - Diana M Gibb
- Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom
| | - Avy Violari
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mariana Kruger
- Family Clinical Research Unit, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Mark Fredric Cotton
- Family Clinical Research Unit, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
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Honeth I, Laughton B, Springer PE, Cotton MF, Pretorius C. Diagnostic accuracy of the Molteno Adapted Scale for developmental delay in South African toddlers. Paediatr Int Child Health 2019; 39:132-138. [PMID: 30328387 DOI: 10.1080/20469047.2018.1528754] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: There is currently a great need in South Africa for culturally appropriate neurodevelopmental screening measures in order to facilitate early identification of neurodevelopmental problems in children. Neurodevelopmental screening has the potential to decrease the burden at health-care facilities as it is time, resource and cost effective. Aim: To assess the use of the Molteno Adapted Scale (MAS), a locally developed screening measure, to suggest an optimal cut-off score and investigate its accuracy in detecting developmental delays. Method: The MAS was assessed by evaluating three components: accuracy, efficacy and usefulness. For each of 136 participants, MAS scores were compared with dichotomised scores from the Griffiths Mental Development Scales (GMDS). Receiver operating characteristic (ROC) curves were generated to determine the accuracy of the MAS in identifying developmental delay defined by the GMDS. Sensitivity, specificity and predictive values were calculated for potential MAS cut-off scores. Results: The MAS had an excellent area under the ROC curve, indicating good test accuracy. A developmental quotient of 83 was identified as optimal for screening purposes, with acceptable sensitivity (71.4%) and specificity (90.7%) as well as predictive values (29.4% positive predictive value and 98.3% negative predictive value) for developmental delay on the GMDS. Conclusion: The present study provides preliminary evidence supporting the use of the MAS for screening.
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Affiliation(s)
- Ingrid Honeth
- a Department of Psychology , Stellenbosch University , Matieland , South Africa
| | - Barbara Laughton
- b Family Clinical Research Unit and Tygerberg Hospital, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - Priscilla E Springer
- c Tygerberg Hospital and Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - Mark Fredric Cotton
- b Family Clinical Research Unit and Tygerberg Hospital, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - Chrisma Pretorius
- a Department of Psychology , Stellenbosch University , Matieland , South Africa
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36
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Ruiseñor-Escudero H, Familiar I, Nyakato M, Kutessa A, Namukooli J, Ssesanga T, Joyce C, Laughton B, Grab J, Chernoff M, Vhembo T, Fairlie L, Kamthunzi P, Boivin M. Building capacity in neurodevelopment assessment of children in sub-Saharan Africa: A quality assurance model to implement standardized neurodevelopment testing. Child Neuropsychol 2019; 25:466-481. [PMID: 30105934 PMCID: PMC6375801 DOI: 10.1080/09297049.2018.1497588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 06/10/2018] [Indexed: 10/28/2022]
Abstract
Compromised neurodevelopment (ND) among infants and children is prevalent in sub-Saharan Africa. Standardized testing of ND is frequently prohibitive in these contexts, as tests require skilled staff for their application. In this paper, we present a quality assurance (QA) model (QualiND) for standardized ND testing, discussing findings and implications from our experience applying the Kaufman Assessment Battery for Children second edition (KABC-II). The QualiND model was implemented within IMPAACT P1104s study, a multisite, prospective study including 615 children affected by HIV. From 2014 to 2016, the QualiND managed 18 testers across 6 sites located in 4 African countries applying the KABC-II in 9 local languages. The QualiND is a multilevel, video-assisted iterative model incorporating remote evaluation, feedback, and supervision roles. Using an ad hoc rubric, videos of test application were evaluated by experienced staff in a centralized QA center. At each study site, testers and supervisors reviewed feedback from videos received via email from the QA center and devised an action plan to address testing errors and deficiencies. There were few instances of invalid tests and few barriers to test completion. Over 97% of KABC-II tests across sites were considered to be valid by the QA center. Overall, the QualiND model was a useful platform for remote supervision to nonspecialist and minimally trained research staff. The QualiND model may be useful to researchers and organizations involved in measuring early child development using standardized tests in low and middle-income countries.
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Affiliation(s)
| | - Itziar Familiar
- a Psychiatry Department , Michigan State University , East Lansing , USA
| | - Mary Nyakato
- b Makerere University-Johns Hopkins University Research Collaboration (MU-JHU) , Kampala , Uganda
| | - Agatha Kutessa
- b Makerere University-Johns Hopkins University Research Collaboration (MU-JHU) , Kampala , Uganda
| | | | | | - Celeste Joyce
- d Chris Hani HIV Unit , University of Witwatersrand , Soweto , South Africa
| | - Barbara Laughton
- e Department of Pediatrics and Child Health , Tygerberg University , Tygerberg , South Africa
| | - Janet Grab
- f Wits Reproductive Health & HIV Institute , Shandukani Clinic , Johannesburg , South Africa
| | - Miriam Chernoff
- g Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health , Harvard University , Boston , USA
| | - Tichaona Vhembo
- h Harare Family Care , University of Zimbabwe , Harare , Zimbabwe
| | - Lee Fairlie
- f Wits Reproductive Health & HIV Institute , Shandukani Clinic , Johannesburg , South Africa
| | - Portia Kamthunzi
- i Lilongwe Clinical Research Institute , Kamuzu Central Hospital , Lilongwe , Malawi
| | - Michael Boivin
- a Psychiatry Department , Michigan State University , East Lansing , USA
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Robertson FC, Holmes MJ, Cotton MF, Dobbels E, Little F, Laughton B, van der Kouwe AJW, Meintjes EM. Perinatal HIV Infection or Exposure Is Associated With Low N-Acetylaspartate and Glutamate in Basal Ganglia at Age 9 but Not 7 Years. Front Hum Neurosci 2018; 12:145. [PMID: 29867401 PMCID: PMC5949349 DOI: 10.3389/fnhum.2018.00145] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 04/03/2018] [Indexed: 02/03/2023] Open
Abstract
Abnormalities of the basal ganglia are frequently seen in HIV-infected (HIV+) children despite antiretroviral treatment (ART) initiation during childhood. Assessment of metabolites associated with neuronal integrity or with glial proliferation can present a sensitive description of metabolic events underlying basal ganglia structural changes. We used magnetic resonance spectroscopy to examine differences in creatine, choline, N-acetylaspartate (NAA), glutamate, and myo-inositol between HIV+ children and HIV-unexposed controls, as well as between HIV-exposed uninfected (HEU) children and HIV-unexposed controls at age 7 and at age 9. No differences in metabolites relative to the HIV-unexposed control group were found at age 7. However, at 9 years, both HIV+ and HEU had lower NAA and glutamate than unexposed control children. HEU children also had lower creatine and choline than control children. At age 7, lower CD4/CD8 ratio at enrollment was associated with lower choline levels. At age 9 lower CD4/CD8 at enrollment was associated with lower myo-inositol. Low NAA and glutamate at age 9, but not 7, suggest that basal ganglia neurons may be particularly affected by perinatal HIV/ART and that neuronal damage may be ongoing despite early ART and viral suppression. Reduced basal ganglia metabolite levels in HEU children suggest an effect of HIV exposure on childhood brain development that merits further investigation using neuroimaging and neurocognitive testing.
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Affiliation(s)
- Frances C Robertson
- Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Martha J Holmes
- Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mark F Cotton
- Family Clinical Research Unit, Department of Paediatrics and Child Health, Tygerberg Children's Hospital and Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Els Dobbels
- Family Clinical Research Unit, Department of Paediatrics and Child Health, Tygerberg Children's Hospital and Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Francesca Little
- Department of Statistical Sciences, Faculty of Sciences, University of Cape Town, Cape Town, South Africa
| | - Barbara Laughton
- Family Clinical Research Unit, Department of Paediatrics and Child Health, Tygerberg Children's Hospital and Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - André J W van der Kouwe
- A. A. Martinos Centre for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, United States.,Department of Radiology, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Ernesta M Meintjes
- Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Nwosu EC, Robertson FC, Holmes MJ, Cotton MF, Dobbels E, Little F, Laughton B, van der Kouwe A, Meintjes EM. Altered brain morphometry in 7-year old HIV-infected children on early ART. Metab Brain Dis 2018; 33:523-535. [PMID: 29209922 PMCID: PMC5866746 DOI: 10.1007/s11011-017-0162-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/27/2017] [Indexed: 12/13/2022]
Abstract
Even with the increased roll out of combination antiretroviral therapy (cART), paediatric HIV infection is associated with neurodevelopmental delays and neurocognitive deficits that may be accompanied by alterations in brain structure. Few neuroimaging studies have been done in children initiating ART before 2 years of age, and even fewer in children within the critical stage of brain development between 5 and 11 years. We hypothesized that early ART would limit HIV-related brain morphometric deficits at age 7. Study participants were 7-year old HIV-infected (HIV+) children from the Children with HIV Early Antiretroviral Therapy (CHER) trial whose viral loads were supressed at a young age, and age-matched uninfected controls. We used structural magnetic resonance imaging (MRI) and FreeSurfer ( http://www.freesurfer.net/ ) software to investigate effects of HIV and age at ART initiation on cortical thickness, gyrification and regional brain volumes. HIV+ children showed reduced gyrification compared to controls in bilateral medial parietal regions, as well as reduced volumes of the right putamen, left hippocampus, and global white and gray matter and thicker cortex in small lateral occipital region. Earlier ART initiation was associated with lower gyrification and thicker cortex in medial frontal regions. Although early ART appears to preserve cortical thickness and volumes of certain brain structures, HIV infection is nevertheless associated with reduced gyrification in the parietal cortex, and lower putamen and hippocampus volumes. Our results indicate that in early childhood gyrification is more sensitive than cortical thickness to timing of ART initiation. Future work will clarify the implications of these morphometric effects for neuropsychological function.
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Affiliation(s)
- Emmanuel C Nwosu
- MRC/UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Frances C Robertson
- MRC/UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Martha J Holmes
- MRC/UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mark F Cotton
- Family Clinical Research Unit, Department of Paediatrics & Child Health, Tygerberg Children's Hospital and Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Els Dobbels
- Family Clinical Research Unit, Department of Paediatrics & Child Health, Tygerberg Children's Hospital and Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Francesca Little
- Department of Statistical Sciences, Faculty of Sciences, University of Cape Town, Cape Town, South Africa
| | - Barbara Laughton
- Family Clinical Research Unit, Department of Paediatrics & Child Health, Tygerberg Children's Hospital and Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Andre van der Kouwe
- A.A. Martinos Centre for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Ernesta M Meintjes
- MRC/UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Thomas A, Dobbels EFM, Springer PE, Ackermann C, Cotton MF, Laughton B. Favourable outcome in a child with symptomatic diagnosis of Glutaric aciduria type 1 despite vertical HIV infection and minor head trauma. Metab Brain Dis 2018; 33:537-544. [PMID: 29427049 DOI: 10.1007/s11011-018-0196-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 01/25/2018] [Indexed: 11/29/2022]
Abstract
The first case of Glutaric aciduria Type 1(GA1) in an African child was reported in 2001. GA1 has a prevalence of 1:5000 in black South Africans. Although early diagnosis is essential for a favourable outcome, newborn screening is not routine in South Africa where an estimated 320,000 children have HIV infection. Neurodevelopmental delay and encephalopathy are complications of both HIV and GA1. In such a setting it is important to recognise that HIV and GA1 can occur simultaneously. We present an HIV-infected South African male child of Xhosa descent with macrocephaly who commenced combination antiretroviral therapy (ART) at 8 weeks of age in a clinical trial which included a neurodevelopmental sub-study. He developed short-lived focal seizures at 16 months after minor head trauma. Neurological examination was normal. Neuroimaging showed temporal lobe atrophy, subtle hyperintense signal change in the globus pallidus, and focal haemosiderosis in the right Sylvian fissure region. As findings were not in keeping with HIV encephalopathy, a urine metabolic screen was undertaken which suggested GA1. Genetic testing confirmed Arg293Trp mutation. He began L-carnitine and a low protein diet as a restricted diet was not practicable. At 21 months he developed pulmonary tuberculosis, requiring 6 months treatment. He did not develop any neurologic motor symptoms. Serial neurodevelopmental and neuropsychological test scores until 9 years were similar to healthy neighbourhood controls, except for mild language delay at 3½ years. Detection of GA1, probably facilitated through participation in a clinical trial, was pivotal for a favourable outcome. The concomitant use of ART and anti-tuberculous therapy in a child with GA1 appears safe.
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Affiliation(s)
- Angeline Thomas
- Developmental Paediatrics, Department of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, South Africa
| | - Els F M Dobbels
- Family Clinical Research Unit, Department of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, South Africa
| | - Priscilla E Springer
- Developmental Paediatrics, Department of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, South Africa
| | - Christelle Ackermann
- Department of Radiology, Tygerberg Hospital and Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, South Africa
| | - Mark F Cotton
- Family Clinical Research Unit, Department of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, South Africa
| | - Barbara Laughton
- Family Clinical Research Unit, Department of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, South Africa.
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Chernoff MC, Laughton B, Ratswana M, Familiar I, Fairlie L, Vhembo T, Kamthunzi P, Kabugho E, Joyce C, Zimmer B, Ariansen JL, Jean-Philippe P, Boivin MJ. Validity of Neuropsychological Testing in Young African Children Affected by HIV. J PEDIAT INF DIS-GER 2018; 13:185-201. [PMID: 30100780 DOI: 10.1055/s-0038-1637020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Introduction Western-constructed neuropsychological tests have been used in low and middle income countries to assess the impact of HIV/AIDS and other chronic illnesses. We explore using such instruments cross-culturally in a sub-Saharan Africa setting. Methods IMPAACT P1104S was a two-year observational study carried out at six clinical sites (South Africa- 3 sites, Malawi, Uganda and Zimbabwe) to assess and compare neuropsychological outcomes in three cohorts of children 5-11 years of age: HIV-infected (HIV), HIV-exposed but uninfected (HEU) and HIV unexposed and uninfected (HU). Descriptive statistics compared socio-demographic characteristics among children at sites. Instruments included the KABC-II cognitive ability, TOVA attention/impulsivity, BOT-2 motor proficiency tests, and BRIEF executive function problems. Test characteristics were assessed using intraclass and Spearman non-parametric correlations, linear regression and principal factor analyses. Results Of the 611 participants, 50% were male and mean age ranged from 6.6 to 8 years. In Malawi, Uganda and Zimbabwe, substantial proportions of families lived in rural settings in contrast to the South African sites. Intraclass correlation coefficients between weeks 0 and 48 were highest for the KABC scores, ranging between 0.42 to 0.71.Correlations among similar test domains were low to moderate but significant, with positive correlation between KABC Sequential and TOVA scores and negative correlation between BRIEF and KABC scores. TOVA response time scores correlated negatively with the BOT-2 Total points score. Strong and significant associations between individual measures of growth, disability and development with all test scores were observed. Performance-based measures were markedly lower for HIV compared to HEU and HU participants, even after controlling for age, sex and site. Factor analyses confirmed the underlying theoretical structure of the KABC scaled item scores. Conclusion The KABC, TOVA, BRIEF and BOT-2 were valid and reliable tools for assessing the neuropsychological impact of HIV in four sub-Saharan African countries.
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Affiliation(s)
- Miriam C Chernoff
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Barbara Laughton
- Family Clinical Research Unit, Tygerberg Hospital, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, RSA
| | - Mmule Ratswana
- Wits Reproductive Health & HIV Institute (WRHI), Shandukani Clinic, Johannesburg, RSA
| | - Itziar Familiar
- Department of Psychiatry, Michigan State University, East Lansing, MI
| | - Lee Fairlie
- Wits Reproductive Health & HIV Institute (WRHI), Shandukani Clinic, Johannesburg, RSA
| | - Tichaona Vhembo
- Harare Family Care CRS, University of Zimbabwe, College of Health Sciences Clinical Trials Unit, Harare, Zimbabwe
| | - Portia Kamthunzi
- University of North Carolina Project- Lilongwe, Malawi CRS, Malawi
| | - Enid Kabugho
- Makerere University-Johns Hopkins University Research Collaboration (MUJHU CARE LTD) CRS, Kampala, Uganda
| | - Celeste Joyce
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, South Africa
| | | | - J L Ariansen
- Clinical Research Management, FHI360, Durham, NC
| | | | - Michael J Boivin
- Department of Psychiatry, Michigan State University, East Lansing, MI.,Department of Neurology and Ophthalmology, Michigan State University, East Lansing, MI.,Department of Psychiatry, the University of Michigan, Ann Arbor, MI
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Toich JTF, Taylor PA, Holmes MJ, Gohel S, Cotton MF, Dobbels E, Laughton B, Little F, van der Kouwe AJW, Biswal B, Meintjes EM. Functional Connectivity Alterations between Networks and Associations with Infant Immune Health within Networks in HIV Infected Children on Early Treatment: A Study at 7 Years. Front Hum Neurosci 2018; 11:635. [PMID: 29375341 PMCID: PMC5768628 DOI: 10.3389/fnhum.2017.00635] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/12/2017] [Indexed: 12/22/2022] Open
Abstract
Although HIV has been shown to impact brain connectivity in adults and youth, it is not yet known to what extent long-term early antiretroviral therapy (ART) may alter these effects, especially during rapid brain development in early childhood. Using both independent component analysis (ICA) and seed-based correlation analysis (SCA), we examine the effects of HIV infection in conjunction with early ART on resting state functional connectivity (FC) in 7 year old children. HIV infected (HIV+) children were from the Children with HIV Early Antiretroviral Therapy (CHER) trial and all initiated ART before 18 months; uninfected children were recruited from an interlinking vaccine trial. To better understand the effects of current and early immune health on the developing brain, we also investigated among HIV+ children the association of FC at 7 years with CD4 count and CD4%, both in infancy (6–8 weeks) and at scan. Although we found no differences within any ICA-generated resting state networks (RSNs) between HIV+ and uninfected children (27 HIV+, 18 uninfected), whole brain connectivity to seeds located at RSN connectivity peaks revealed several loci of FC differences, predominantly from seeds in midline regions (posterior cingulate cortex, paracentral lobule, cuneus, and anterior cingulate). Reduced long-range connectivity and increased short-range connectivity suggest developmental delay. Within the HIV+ children, clinical measures at age 7 years were not associated with FC values in any of the RSNs; however, poor immune health during infancy was associated with localized FC increases in the somatosensory, salience and basal ganglia networks. Together these findings suggest that HIV may affect brain development from its earliest stages and persist into childhood, despite early ART.
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Affiliation(s)
- Jadrana T F Toich
- MRC/UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Paul A Taylor
- MRC/UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,African Institute for Mathematical Sciences, Muizenberg, South Africa.,Scientific and Statistical Computing Core, National Institutes of Health, Bethesda, MD, United States
| | - Martha J Holmes
- MRC/UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Suril Gohel
- Department of Health Informatics, School of Health Professions, Rutgers University, Newark, NJ, United States
| | - Mark F Cotton
- Family Clinical Research Unit, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Els Dobbels
- Family Clinical Research Unit, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Barbara Laughton
- Family Clinical Research Unit, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Francesca Little
- Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Bharat Biswal
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
| | - Ernesta M Meintjes
- MRC/UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Springer PE, Slogrove AL, Laughton B, Bettinger JA, Saunders HH, Molteno CD, Kruger M. Neurodevelopmental outcome of HIV-exposed but uninfected infants in the Mother and Infants Health Study, Cape Town, South Africa. Trop Med Int Health 2017; 23:69-78. [PMID: 29131457 DOI: 10.1111/tmi.13006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare neurodevelopmental outcomes of HIV-exposed uninfected (HEU) and HIV-unexposed uninfected (HUU) infants in a peri-urban South African population. HEU infants living in Africa face unique biological and environmental risks, but uncertainty remains regarding their neurodevelopmental outcome. This is partly due to lack of well-matched HUU comparison groups needed to adjust for confounding factors. METHODS This was a prospective cohort study of infants enrolled at birth from a low-risk midwife obstetric facility. At 12 months of age, HEU and HUU infant growth and neurodevelopmental outcomes were compared. Growth was evaluated as WHO weight-for-age, length-for-age, weight-for-length and head-circumference-for-age Z-scores. Neurodevelopmental outcomes were evaluated using the Bayley scales of Infant Development III (BSID) and Alarm Distress Baby Scale (ADBB). RESULTS Fifty-eight HEU and 38 HUU infants were evaluated at 11-14 months of age. Performance on the BSID did not differ in any of the domains between HEU and HUU infants. The cognitive, language and motor scores were within the average range (US standardised norms). Seven (12%) HEU and 1 (2.6%) HUU infant showed social withdrawal on the ADBB (P = 0.10), while 15 (26%) HEU and 4 (11%) HUU infants showed decreased vocalisation (P = 0.06). There were no growth differences. Three HEU and one HUU infant had minor neurological signs, while eight HEU and two HUU infants had macrocephaly. CONCLUSIONS Although findings on the early neurodevelopmental outcome of HEU infants are reassuring, minor differences in vocalisation and on neurological examination indicate a need for reassessment at a later age.
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Affiliation(s)
- Priscilla E Springer
- Department of Paediatrics & Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Amy L Slogrove
- Department of Paediatrics & Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Ukwanda Centre for Rural Health, Worcester, South Africa
| | - Barbara Laughton
- Family Clinical Research Unit, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Julie A Bettinger
- Vaccine Evaluation Center, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Henriëtte H Saunders
- Department of Paediatrics & Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Mariana Kruger
- Department of Paediatrics & Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Randall SR, Warton CMR, Holmes MJ, Cotton MF, Laughton B, van der Kouwe AJW, Meintjes EM. Larger Subcortical Gray Matter Structures and Smaller Corpora Callosa at Age 5 Years in HIV Infected Children on Early ART. Front Neuroanat 2017; 11:95. [PMID: 29163068 PMCID: PMC5673662 DOI: 10.3389/fnana.2017.00095] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 10/16/2017] [Indexed: 11/13/2022] Open
Abstract
Sub-Saharan Africa is home to 90% of HIV infected (HIV+) children. Since the advent of antiretroviral therapy (ART), HIV/AIDS has transitioned to a chronic condition where central nervous system (CNS) damage may be ongoing. Although, most guidelines recommend early ART to reduce CNS viral reservoirs, the brain may be more vulnerable to potential neurotoxic effects of ART during the rapid development phase in the first years of life. Here we investigate differences in subcortical volumes between 5-year-old HIV+ children who received early ART (before age 18 months) and uninfected children using manual tracing of Magnetic Resonance Images. Participants included 61 Xhosa children (43 HIV+/18 uninfected, mean age = 5.4 ± 0.3 years, 25 male) from the children with HIV early antiretroviral (CHER) trial; 27 children initiated ART before 12 weeks of age (ART-Before12Wks) and 16 after 12 weeks (ART-After12Wks). Structural images were acquired on a 3T Allegra MRI in Cape Town and manually traced using MultiTracer. Volumetric group differences (HIV+ vs. uninfected; ART-Before12Wks vs. ART-After12Wks) were examined for the caudate, nucleus accumbens (NA), putamen (Pu), globus pallidus (GP), and corpus callosum (CC), as well as associations within infected children of structure volumes with age at ART initiation and CD4/CD8 as a proxy for immune health. HIV+ children had significantly larger NA and Pu volumes bilaterally and left GP volumes than controls, whilst CC was smaller. Bilateral Pu was larger in both treatment groups compared to controls, while left GP and bilateral NA were enlarged only in ART-After12Wks children. CC was smaller in both treatment groups compared to controls, and smaller in ART-After12Wks compared to ART-Before12Wks. Within infected children, delayed ART initiation was associated with larger Pu volumes, effects that remained significant when controlling for sex and duration of treatment interruption (left β = 0.447, p = 0.005; right β = 0.325, p = 0.051), and lower CD4/CD8 with larger caudates controlling for sex (left β = -0.471, p = 0.002; right β = -0.440, p = 0.003). Volumetric differences were greater in children who initiated ART after 12 weeks. Results suggest damage is ongoing despite early ART and viral load suppression; however, earlier treatment is neuroprotective.
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Affiliation(s)
- Steven R. Randall
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Christopher M. R. Warton
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Martha J. Holmes
- MRC/UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mark F. Cotton
- Children's Infectious Diseases Clinical Research Unit, Department of Paediatrics and Child Health, Tygerberg Children's Hospital & Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Barbara Laughton
- Children's Infectious Diseases Clinical Research Unit, Department of Paediatrics and Child Health, Tygerberg Children's Hospital & Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Andre J. W. van der Kouwe
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States
| | - Ernesta M. Meintjes
- MRC/UCT Medical Imaging Research Unit, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Van Zyl GU, Katusiime MG, Wiegand A, McManus WR, Bale MJ, Halvas EK, Luke B, Boltz VF, Spindler J, Laughton B, Engelbrecht S, Coffin JM, Cotton MF, Shao W, Mellors JW, Kearney MF. No evidence of HIV replication in children on antiretroviral therapy. J Clin Invest 2017; 127:3827-3834. [PMID: 28891813 PMCID: PMC5617669 DOI: 10.1172/jci94582] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 07/26/2017] [Indexed: 12/21/2022] Open
Abstract
It remains controversial whether current antiretroviral therapy (ART) fully suppresses the cycles of HIV replication and viral evolution in vivo. If replication persists in sanctuary sites such as the lymph nodes, a high priority should be placed on improving ART regimes to target these sites. To investigate the question of ongoing viral replication on current ART regimens, we analyzed HIV populations in longitudinal samples from 10 HIV-1-infected children who initiated ART when viral diversity was low. Eight children started ART at less than ten months of age and showed suppression of plasma viremia for seven to nine years. Two children had uncontrolled viremia for fifteen and thirty months, respectively, before viremia suppression, and served as positive controls for HIV replication and evolution. These latter 2 children showed clear evidence of virus evolution, whereas multiple methods of analysis bore no evidence of virus evolution in any of the 8 children with viremia suppression on ART. Phylogenetic trees simulated with the recently reported evolutionary rate of HIV-1 on ART of 6 × 10-4 substitutions/site/month bore no resemblance to the observed data. Taken together, these data refute the concept that ongoing HIV replication is common with ART and is the major barrier to curing HIV-1 infection.
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Affiliation(s)
- Gert U. Van Zyl
- Division of Medical Virology, Stellenbosch University and National Health Laboratory Service (NHLS) Tygerberg, Cape Town, South Africa
| | - Mary Grace Katusiime
- Division of Medical Virology, Stellenbosch University and National Health Laboratory Service (NHLS) Tygerberg, Cape Town, South Africa
| | - Ann Wiegand
- HIV Dynamics and Replication Program, National Cancer Institute (NCI), Frederick, Maryland, USA
| | - William R. McManus
- HIV Dynamics and Replication Program, National Cancer Institute (NCI), Frederick, Maryland, USA
| | - Michael J. Bale
- HIV Dynamics and Replication Program, National Cancer Institute (NCI), Frederick, Maryland, USA
| | - Elias K. Halvas
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brian Luke
- Advanced Biomedical Computing Center, Leidos Biomedical Research Inc. and Frederick National Laboratories for Cancer Research, Frederick, Maryland, USA
| | - Valerie F. Boltz
- HIV Dynamics and Replication Program, National Cancer Institute (NCI), Frederick, Maryland, USA
| | - Jonathan Spindler
- HIV Dynamics and Replication Program, National Cancer Institute (NCI), Frederick, Maryland, USA
| | - Barbara Laughton
- Department Pediatrics and Child Health, Tygerberg Children’s Hospital and Family Clinical Research Unit, Stellenbosch University, Cape Town, South Africa
| | - Susan Engelbrecht
- Division of Medical Virology, Stellenbosch University and National Health Laboratory Service (NHLS) Tygerberg, Cape Town, South Africa
| | - John M. Coffin
- Department of Molecular Biology and Microbiology, Tufts University, Boston, Massachusetts, USA
| | - Mark F. Cotton
- Department Pediatrics and Child Health, Tygerberg Children’s Hospital and Family Clinical Research Unit, Stellenbosch University, Cape Town, South Africa
| | - Wei Shao
- Advanced Biomedical Computing Center, Leidos Biomedical Research Inc. and Frederick National Laboratories for Cancer Research, Frederick, Maryland, USA
| | - John W. Mellors
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary F. Kearney
- HIV Dynamics and Replication Program, National Cancer Institute (NCI), Frederick, Maryland, USA
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Jankiewicz M, Holmes MJ, Taylor PA, Cotton MF, Laughton B, van der Kouwe AJW, Meintjes EM. White Matter Abnormalities in Children with HIV Infection and Exposure. Front Neuroanat 2017; 11:88. [PMID: 29033797 PMCID: PMC5627060 DOI: 10.3389/fnana.2017.00088] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/20/2017] [Indexed: 11/13/2022] Open
Abstract
Background: Due to changes in guidelines and access to treatment, more children start combination antiretroviral therapy (ART) in infancy. With few studies examining the long-term effects of perinatal HIV infection and early ART on neurodevelopment, much is still unknown about brain maturation in the presence of HIV and ART. Follow-up studies of HIV infected (HIV+) children are important for monitoring brain development in the presence of HIV infection and ART. Methods: We use diffusion tensor imaging (DTI) to examine white matter (WM) in 65 HIV+ and 46 control (HIV exposed uninfected (HEU) and HIV unexposed uninfected (HU)) 7-year-old children. This is a follow up of a cohort studied at 5 years, where we previously reported lower fractional anisotropy (FA) in corticospinal tract (CST) and mean diffusivity (MD) increases in inferior/superior longitudinal fasciculi (ILF/SLF), inferior fronto-occipital fasciculus (IFOF) and uncinate fasciculus (UF) in HIV+ children compared to uninfected controls. In addition, we also found a difference in FA related to age at which ART was initiated. Results: At 7 years, we found two regions in the left IFOF and left ILF with lower FA in HIV+ children compared to controls. Higher MD was observed in a similar region in the IFOF, albeit bilaterally, as well as multiple clusters bilaterally in the superior corona radiata (SCR), the anterior thalamic radiation (ATR) and the right forceps minor. Unlike at 5 years, we found no impact on WM of ART initiation. In HEU children, we found a cluster in the right posterior corona radiata with higher FA compared to HU children, while bilateral regions in the CST demonstrated reduced MD. Conclusions: At age 7, despite early ART and viral load (VL) suppression, we continue to observe differences in WM integrity. WM damage observed at age 5 years persists, and new damage is evident. The continued observation of regions with lower FA and higher MD in HIV+ children point to disruptions in ongoing white matter development regardless of early ART. Lastly, in HEU children we find higher FA and lower MD in clusters in the CST tract suggesting that perinatal HIV/ART exposure has a long-term impact on WM development.
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Affiliation(s)
- Marcin Jankiewicz
- Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Martha J Holmes
- Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Paul A Taylor
- Scientific and Statistical Computing Core, National Institutes of Health, Bethesda, MD, United States
| | | | | | - André J W van der Kouwe
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States
| | - Ernesta M Meintjes
- Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa
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Mann TN, Donald KA, Laughton B, Lamberts RP, Langerak NG. HIV encephalopathy with bilateral lower limb spasticity: upper limb motor function and level of activity and participation. Dev Med Child Neurol 2017; 59:412-419. [PMID: 27573542 DOI: 10.1111/dmcn.13236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2016] [Indexed: 11/30/2022]
Abstract
AIM To describe upper limb motor function and level of activity and participation in children with HIV encephalopathy (HIVE) and bilateral lower limb (BLL) spasticity. METHOD Thirty ambulant children with HIVE and BLL spasticity and 20 typically developing children, between 5 years and 12 years, were recruited. Upper limb motor function was assessed using the Purdue Pegboard and level of activity and participation using the Computer-Adapted Pediatric Evaluation of Disabilities Inventory (PEDI-CAT). RESULTS The HIVE group comprised 14 males and 16 females (mean age [SD] 8y 8mo [2y 2mo], Gross Motor Function Classification System (GMFCS) level I [n=10], II [n=11], and III [n=9]) and the typically developing group comprised 11 males and 9 females (mean age 8y 8mo [2y 3mo]). The HIVE group had lower scores than the typically developing group for all pegboard tasks and three of the four PEDI-CAT domains (p≤0.001). However, individual outcome scores varied substantially within each GMFCS level. INTERPRETATION Children with HIVE and BLL spasticity may have significantly poorer upper limb motor performance and lower levels of activity and participation than typically developing children. These findings suggest that an assessment of upper limb motor function should form part of optimal care for this population.
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Affiliation(s)
- Theresa N Mann
- Division of Neurosurgery, Department of Surgery, University of Cape Town, Cape Town, South Africa.,Division of Orthopedic Surgery, Department of Surgical Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Kirsten A Donald
- Division of Developmental Pediatrics, Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Barbara Laughton
- Children's Infectious Diseases Clinical Research Unit, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Robert P Lamberts
- Division of Orthopedic Surgery, Department of Surgical Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Nelleke G Langerak
- Division of Neurosurgery, Department of Surgery, University of Cape Town, Cape Town, South Africa
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Mann TN, Laughton B, Donald KA, Langerak NG. HIV encephalopathy with bilateral lower limb spasticity: gross motor function and antiretroviral therapy. Dev Med Child Neurol 2017; 59:407-411. [PMID: 28111750 DOI: 10.1111/dmcn.13377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 11/29/2022]
Abstract
AIM To describe gross motor function in children with bilateral lower limb (BLL) spasticity due to human immunodeficiency virus encephalopathy (HIVE), and to investigate the association between age, CD4 percentage, and viral load at initiation of antiretroviral therapy (ART) and current gross motor function. METHOD Thirty ambulant children with HIVE and BLL spasticity were recruited. Clinical parameters, including ART, were obtained from medical records. Gross motor function was assessed using the 88-item Gross Motor Function Measure (GMFM-88). RESULTS The participant group was comprised of 14 males and 16 females (median age 8y; interquartile range [IQR] 7-11y). ART was initiated at a median age of 7 months (IQR 5-11mo) with a median CD4 percentage of 4.7% (IQR 2.3-8.0) and viral load of log10 6.0 (IQR 5.6-6.4). The median total GMFM-88 score was 89% (IQR 78-94%), with a wide range of scores in the 'Standing' domain (26-97%) and 'Walking, Running, and Jumping' domain (8-99%). No associations were detected between age at initiation of ART, CD4 percentage, or viral load and total GMFM-88 score. INTERPRETATION Limitations in gross motor function in children with HIVE and BLL spasticity range from mild to severe. ART initiation factors were not able to predict functional status in this sample.
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Affiliation(s)
- Theresa N Mann
- Division of Neurosurgery, Department of Surgery, University of Cape Town, Cape Town, South Africa.,Division of Orthopedic Surgery, Department of Surgical Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Barbara Laughton
- Children's Infectious Diseases Clinical Research Unit, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Kirsten A Donald
- Division of Developmental Pediatrics, Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Nelleke G Langerak
- Division of Neurosurgery, Department of Surgery, University of Cape Town, Cape Town, South Africa
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Ackermann C, Andronikou S, Saleh MG, Laughton B, Alhamud AA, van der Kouwe A, Kidd M, Cotton MF, Meintjes EM. Early Antiretroviral Therapy in HIV-Infected Children Is Associated with Diffuse White Matter Structural Abnormality and Corpus Callosum Sparing. AJNR Am J Neuroradiol 2016; 37:2363-2369. [PMID: 27538904 DOI: 10.3174/ajnr.a4921] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/04/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE Fractional anisotropy in the frontal white matter, corpus callosum, and internal capsule is abnormal in human immunodeficiency virus-positive (HIV+) adults. We describe the distribution and nature of white matter abnormalities in a cohort of children who started antiretroviral therapy within the first year of life and the benefit of early treatment by using DTI measures (fractional anisotropy and mean, axial, and radial diffusion). MATERIALS AND METHODS DTI was performed on children in a neurodevelopmental substudy from the Children with HIV Early Antiretroviral trial. Voxel-based group comparisons were obtained to determine regions where fractional anisotropy and mean diffusion differed between HIV+ and uninfected children. Associations of DTI parameters with the timing of antiretroviral therapy initiation were examined. RESULTS Thirty-nine HIV+ children (15 boys; mean age, 5.4 years) and 13 controls (5 boys; mean age, 5.7 years) were scanned. Two clusters with lower fractional anisotropy and 7 clusters with increased mean diffusion were identified in the HIV+ group, with symmetric distribution predominantly due to increased radial diffusion, suggestive of decreased myelination. Corticospinal tracts rather than the corpus callosum were predominantly involved. Children on early-interrupted antiretroviral therapy had lower fractional anisotropy compared with those receiving continuous treatment. CONCLUSIONS HIV+ children at 5 years of age have white matter abnormalities measured by fractional anisotropy, despite early antiretroviral therapy, suggesting that early antiretroviral therapy does not fully protect the white matter from either peripartum or in utero infection. In contrast to adults, the corticospinal tracts are predominantly involved rather than the corpus callosum, possibly due to early antiretroviral therapy. Continuous early antiretroviral therapy can limit white matter damage.
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Affiliation(s)
- C Ackermann
- From the Departments of Radiodiagnosis (C.A.)
| | - S Andronikou
- Clinical Research and Imaging Centre, Bristol (S.A.), University of Bristol, Bristol, UK
- Department of Paediatric Radiology (S.A.), Bristol Royal Hospital for Children, Bristol, UK
| | - M G Saleh
- Department of Human Biology (M.G.S., A.A.A., E.M.M.), Medical Research Council/University of Cape Town Medical Imaging Research Unit, University of Cape Town, Cape Town, South Africa
| | - B Laughton
- Paediatrics and Child Health (B.L., M.F.C.), Faculty of Medicine and Health Sciences
| | - A A Alhamud
- Department of Human Biology (M.G.S., A.A.A., E.M.M.), Medical Research Council/University of Cape Town Medical Imaging Research Unit, University of Cape Town, Cape Town, South Africa
| | - A van der Kouwe
- Athinoula A. Martinos Center for Biomedical Imaging (A.v.d.K.), Massachusetts General Hospital, Charlestown, Massachusetts
| | - M Kidd
- Centre for Statistical Consultation (M.K.), Stellenbosch University, Tygerberg, South Africa
| | - M F Cotton
- Paediatrics and Child Health (B.L., M.F.C.), Faculty of Medicine and Health Sciences
| | - E M Meintjes
- Department of Human Biology (M.G.S., A.A.A., E.M.M.), Medical Research Council/University of Cape Town Medical Imaging Research Unit, University of Cape Town, Cape Town, South Africa
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Robertson F, Holmes M, Little F, Cotton M, Dobbels E, van der Kouwe A, Laughton B, Meintjes E. P6. Comparison of water signal T2 biexponential fitting and image segmentation to determine voxel CSF fraction in magnetic resonance spectroscopy. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.07.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Holmes M, Robertson F, Little F, Cotton M, Dobbels E, van der Kouwe A, Laughton B, Meintjes E. O50. Regional differences in absolute metabolite level couplings in a longitudinal study of children. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.07.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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