Cognitive Function and Neurodevelopmental Outcomes in HIV-Infected Children Older than 1 Year of Age Randomized to Early Versus Deferred Antiretroviral Therapy: The PREDICT Neurodevelopmental Study
Identifieur interne : 001D18 ( Pmc/Corpus ); précédent : 001D17; suivant : 001D19Cognitive Function and Neurodevelopmental Outcomes in HIV-Infected Children Older than 1 Year of Age Randomized to Early Versus Deferred Antiretroviral Therapy: The PREDICT Neurodevelopmental Study
Auteurs : Thanyawee Puthanakit ; Jintanat Ananworanich ; Saphonn Vonthanak ; Pope Kosalaraksa ; Rawiwan Hansudewechakul ; Jasper Van Der Lugt ; Stephen J. Kerr ; Suparat Kanjanavanit ; Chaiwat Ngampiyaskul ; Jurai Wongsawat ; Wicharn Luesomboon ; Ung Vibol ; Kanchana Pruksakaew ; Tulathip Suwarnlerk ; Tanakorn Apornpong ; Kattiya Ratanadilok ; Robert Paul ; Lynne M. Mofenson ; Lawrence Fox ; Victor Valcour ; Pim Brouwers ; Kiat RuxrungthamSource :
- The Pediatric infectious disease journal [ 0891-3668 ] ; 2013.
Abstract
We previously reported similar AIDS-free survival at 3 years in children who were >1 year old initiating antiretroviral therapy (ART) and randomized to early vs. deferred ART in the PREDICT Study. We now report neurodevelopmental outcomes.
284 HIV-infected Thai and Cambodian children aged 1–12 years with CD4 counts between 15–24% and no AIDS-defining illness were randomized to initiate ART at enrollment (“early”, n=139) or when CD4 count became <15% or a CDC C event developed (“deferred”, n=145). All underwent age-appropriate neurodevelopment testing including Beery Visual Motor Integration (VMI), Purdue Pegboard, Color Trails and Child Behavioral Checklist (CBCL). Thai children (n=170) also completed Wechsler Intelligence Scale (IQ) and Stanford Binet Memory test. We compared week 144 measures by randomized group and to HIV-uninfected children (n=319).
At week 144, the median age was 9 years and 69 (48%) of the deferred arm children had initiated ART. The early arm had a higher CD4 (33% vs. 24%, p<0.001) and a greater percentage of children with viral suppression (91% vs. 40%, p<0.001). Neurodevelopmental scores did not differ by arm and there were no differences in changes between arms across repeated assessments in time-varying multivariate models. HIV-infected children performed worse than uninfected children on IQ, Beery VMI, Binet memory and CBCL
In HIV-infected children surviving beyond one year of age without ART, neurodevelopmental outcomes were similar with ART initiation at CD4 15–24% vs. < 15%; but both groups performed worse than HIV-uninfected children. The window of opportunity for a positive effect of ART initiation on neurodevelopment may remain in infancy.
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DOI: 10.1097/INF.0b013e31827fb19d
PubMed: 23263176
PubMed Central: 3664246
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Cognitive Function and Neurodevelopmental Outcomes in HIV-Infected Children Older than 1 Year of Age Randomized to Early Versus Deferred Antiretroviral Therapy: The PREDICT Neurodevelopmental Study</title><author><name sortKey="Puthanakit, Thanyawee" sort="Puthanakit, Thanyawee" uniqKey="Puthanakit T" first="Thanyawee" last="Puthanakit">Thanyawee Puthanakit</name><affiliation><nlm:aff id="A1">HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand</nlm:aff></affiliation><affiliation><nlm:aff id="A2">Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand</nlm:aff></affiliation></author><author><name sortKey="Ananworanich, Jintanat" sort="Ananworanich, Jintanat" uniqKey="Ananworanich J" first="Jintanat" last="Ananworanich">Jintanat Ananworanich</name><affiliation><nlm:aff id="A1">HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand</nlm:aff></affiliation><affiliation><nlm:aff id="A3">Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand</nlm:aff></affiliation><affiliation><nlm:aff id="A4">SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand</nlm:aff></affiliation><affiliation><nlm:aff id="A8">The Amsterdam Institute of Global Health and Development, Amsterdam, The Netherlands</nlm:aff></affiliation><affiliation><nlm:aff id="A9">The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW, Australia</nlm:aff></affiliation></author><author><name sortKey="Vonthanak, Saphonn" sort="Vonthanak, Saphonn" uniqKey="Vonthanak S" first="Saphonn" last="Vonthanak">Saphonn Vonthanak</name><affiliation><nlm:aff id="A5">National Center for HIV/AIDS Dermatology and STDs, Phnom Penh, Cambodia</nlm:aff></affiliation></author><author><name sortKey="Kosalaraksa, Pope" sort="Kosalaraksa, Pope" uniqKey="Kosalaraksa P" first="Pope" last="Kosalaraksa">Pope Kosalaraksa</name><affiliation><nlm:aff id="A6">Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand</nlm:aff></affiliation></author><author><name sortKey="Hansudewechakul, Rawiwan" sort="Hansudewechakul, Rawiwan" uniqKey="Hansudewechakul R" first="Rawiwan" last="Hansudewechakul">Rawiwan Hansudewechakul</name><affiliation><nlm:aff id="A7">Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand</nlm:aff></affiliation></author><author><name sortKey="Van Der Lugt, Jasper" sort="Van Der Lugt, Jasper" uniqKey="Van Der Lugt J" first="Jasper" last="Van Der Lugt">Jasper Van Der Lugt</name><affiliation><nlm:aff id="A1">HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand</nlm:aff></affiliation><affiliation><nlm:aff id="A8">The Amsterdam Institute of Global Health and Development, Amsterdam, The Netherlands</nlm:aff></affiliation></author><author><name sortKey="Kerr, Stephen J" sort="Kerr, Stephen J" uniqKey="Kerr S" first="Stephen J." last="Kerr">Stephen J. Kerr</name><affiliation><nlm:aff id="A1">HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand</nlm:aff></affiliation><affiliation><nlm:aff id="A9">The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW, Australia</nlm:aff></affiliation></author><author><name sortKey="Kanjanavanit, Suparat" sort="Kanjanavanit, Suparat" uniqKey="Kanjanavanit S" first="Suparat" last="Kanjanavanit">Suparat Kanjanavanit</name><affiliation><nlm:aff id="A10">Nakornping Hospital, Chiang Mai, Thailand</nlm:aff></affiliation></author><author><name sortKey="Ngampiyaskul, Chaiwat" sort="Ngampiyaskul, Chaiwat" uniqKey="Ngampiyaskul C" first="Chaiwat" last="Ngampiyaskul">Chaiwat Ngampiyaskul</name><affiliation><nlm:aff id="A11">Prapokklao Hospital, Chantaburi, Thailand</nlm:aff></affiliation></author><author><name sortKey="Wongsawat, Jurai" sort="Wongsawat, Jurai" uniqKey="Wongsawat J" first="Jurai" last="Wongsawat">Jurai Wongsawat</name><affiliation><nlm:aff id="A12">Bamrasnaradura Infectious Diseases Institute, Nonthaburi, Thailand</nlm:aff></affiliation></author><author><name sortKey="Luesomboon, Wicharn" sort="Luesomboon, Wicharn" uniqKey="Luesomboon W" first="Wicharn" last="Luesomboon">Wicharn Luesomboon</name><affiliation><nlm:aff id="A13">Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand</nlm:aff></affiliation></author><author><name sortKey="Vibol, Ung" sort="Vibol, Ung" uniqKey="Vibol U" first="Ung" last="Vibol">Ung Vibol</name><affiliation><nlm:aff id="A14">National Pediatric Hospital, Phnom Penh, Cambodia</nlm:aff></affiliation></author><author><name sortKey="Pruksakaew, Kanchana" sort="Pruksakaew, Kanchana" uniqKey="Pruksakaew K" first="Kanchana" last="Pruksakaew">Kanchana Pruksakaew</name><affiliation><nlm:aff id="A1">HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand</nlm:aff></affiliation></author><author><name sortKey="Suwarnlerk, Tulathip" sort="Suwarnlerk, Tulathip" uniqKey="Suwarnlerk T" first="Tulathip" last="Suwarnlerk">Tulathip Suwarnlerk</name><affiliation><nlm:aff id="A1">HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand</nlm:aff></affiliation></author><author><name sortKey="Apornpong, Tanakorn" sort="Apornpong, Tanakorn" uniqKey="Apornpong T" first="Tanakorn" last="Apornpong">Tanakorn Apornpong</name><affiliation><nlm:aff id="A1">HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand</nlm:aff></affiliation></author><author><name sortKey="Ratanadilok, Kattiya" sort="Ratanadilok, Kattiya" uniqKey="Ratanadilok K" first="Kattiya" last="Ratanadilok">Kattiya Ratanadilok</name><affiliation><nlm:aff id="A15">Department of Juvenile Observation and Protection, Ministry of Justice, Thailand</nlm:aff></affiliation></author><author><name sortKey="Paul, Robert" sort="Paul, Robert" uniqKey="Paul R" first="Robert" last="Paul">Robert Paul</name><affiliation><nlm:aff id="A16">Department of Psychology, University of Missouri, St. Louis, MO, USA</nlm:aff></affiliation></author><author><name sortKey="Mofenson, Lynne M" sort="Mofenson, Lynne M" uniqKey="Mofenson L" first="Lynne M." last="Mofenson">Lynne M. Mofenson</name><affiliation><nlm:aff id="A17"><italic>Eunice Kennedy Shriver</italic> National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA</nlm:aff></affiliation></author><author><name sortKey="Fox, Lawrence" sort="Fox, Lawrence" uniqKey="Fox L" first="Lawrence" last="Fox">Lawrence Fox</name><affiliation><nlm:aff id="A18">Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA</nlm:aff></affiliation></author><author><name sortKey="Valcour, Victor" sort="Valcour, Victor" uniqKey="Valcour V" first="Victor" last="Valcour">Victor Valcour</name><affiliation><nlm:aff id="A4">SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand</nlm:aff></affiliation><affiliation><nlm:aff id="A19">Memory and Aging Center, University of California at San Francisco, CA, USA</nlm:aff></affiliation></author><author><name sortKey="Brouwers, Pim" sort="Brouwers, Pim" uniqKey="Brouwers P" first="Pim" last="Brouwers">Pim Brouwers</name><affiliation><nlm:aff id="A20">National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA</nlm:aff></affiliation></author><author><name sortKey="Ruxrungtham, Kiat" sort="Ruxrungtham, Kiat" uniqKey="Ruxrungtham K" first="Kiat" last="Ruxrungtham">Kiat Ruxrungtham</name><affiliation><nlm:aff id="A1">HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand</nlm:aff></affiliation><affiliation><nlm:aff id="A3">Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">23263176</idno><idno type="pmc">3664246</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3664246</idno><idno type="RBID">PMC:3664246</idno><idno type="doi">10.1097/INF.0b013e31827fb19d</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">001D18</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001D18</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Cognitive Function and Neurodevelopmental Outcomes in HIV-Infected Children Older than 1 Year of Age Randomized to Early Versus Deferred Antiretroviral Therapy: The PREDICT Neurodevelopmental Study</title><author><name sortKey="Puthanakit, Thanyawee" sort="Puthanakit, Thanyawee" uniqKey="Puthanakit T" first="Thanyawee" last="Puthanakit">Thanyawee Puthanakit</name><affiliation><nlm:aff id="A1">HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand</nlm:aff></affiliation><affiliation><nlm:aff id="A2">Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand</nlm:aff></affiliation></author><author><name sortKey="Ananworanich, Jintanat" sort="Ananworanich, Jintanat" uniqKey="Ananworanich J" first="Jintanat" last="Ananworanich">Jintanat Ananworanich</name><affiliation><nlm:aff id="A1">HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand</nlm:aff></affiliation><affiliation><nlm:aff id="A3">Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand</nlm:aff></affiliation><affiliation><nlm:aff id="A4">SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand</nlm:aff></affiliation><affiliation><nlm:aff id="A8">The Amsterdam Institute of Global Health and Development, Amsterdam, The Netherlands</nlm:aff></affiliation><affiliation><nlm:aff id="A9">The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW, Australia</nlm:aff></affiliation></author><author><name sortKey="Vonthanak, Saphonn" sort="Vonthanak, Saphonn" uniqKey="Vonthanak S" first="Saphonn" last="Vonthanak">Saphonn Vonthanak</name><affiliation><nlm:aff id="A5">National Center for HIV/AIDS Dermatology and STDs, Phnom Penh, Cambodia</nlm:aff></affiliation></author><author><name sortKey="Kosalaraksa, Pope" sort="Kosalaraksa, Pope" uniqKey="Kosalaraksa P" first="Pope" last="Kosalaraksa">Pope Kosalaraksa</name><affiliation><nlm:aff id="A6">Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand</nlm:aff></affiliation></author><author><name sortKey="Hansudewechakul, Rawiwan" sort="Hansudewechakul, Rawiwan" uniqKey="Hansudewechakul R" first="Rawiwan" last="Hansudewechakul">Rawiwan Hansudewechakul</name><affiliation><nlm:aff id="A7">Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand</nlm:aff></affiliation></author><author><name sortKey="Van Der Lugt, Jasper" sort="Van Der Lugt, Jasper" uniqKey="Van Der Lugt J" first="Jasper" last="Van Der Lugt">Jasper Van Der Lugt</name><affiliation><nlm:aff id="A1">HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand</nlm:aff></affiliation><affiliation><nlm:aff id="A8">The Amsterdam Institute of Global Health and Development, Amsterdam, The Netherlands</nlm:aff></affiliation></author><author><name sortKey="Kerr, Stephen J" sort="Kerr, Stephen J" uniqKey="Kerr S" first="Stephen J." last="Kerr">Stephen J. Kerr</name><affiliation><nlm:aff id="A1">HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand</nlm:aff></affiliation><affiliation><nlm:aff id="A9">The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW, Australia</nlm:aff></affiliation></author><author><name sortKey="Kanjanavanit, Suparat" sort="Kanjanavanit, Suparat" uniqKey="Kanjanavanit S" first="Suparat" last="Kanjanavanit">Suparat Kanjanavanit</name><affiliation><nlm:aff id="A10">Nakornping Hospital, Chiang Mai, Thailand</nlm:aff></affiliation></author><author><name sortKey="Ngampiyaskul, Chaiwat" sort="Ngampiyaskul, Chaiwat" uniqKey="Ngampiyaskul C" first="Chaiwat" last="Ngampiyaskul">Chaiwat Ngampiyaskul</name><affiliation><nlm:aff id="A11">Prapokklao Hospital, Chantaburi, Thailand</nlm:aff></affiliation></author><author><name sortKey="Wongsawat, Jurai" sort="Wongsawat, Jurai" uniqKey="Wongsawat J" first="Jurai" last="Wongsawat">Jurai Wongsawat</name><affiliation><nlm:aff id="A12">Bamrasnaradura Infectious Diseases Institute, Nonthaburi, Thailand</nlm:aff></affiliation></author><author><name sortKey="Luesomboon, Wicharn" sort="Luesomboon, Wicharn" uniqKey="Luesomboon W" first="Wicharn" last="Luesomboon">Wicharn Luesomboon</name><affiliation><nlm:aff id="A13">Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand</nlm:aff></affiliation></author><author><name sortKey="Vibol, Ung" sort="Vibol, Ung" uniqKey="Vibol U" first="Ung" last="Vibol">Ung Vibol</name><affiliation><nlm:aff id="A14">National Pediatric Hospital, Phnom Penh, Cambodia</nlm:aff></affiliation></author><author><name sortKey="Pruksakaew, Kanchana" sort="Pruksakaew, Kanchana" uniqKey="Pruksakaew K" first="Kanchana" last="Pruksakaew">Kanchana Pruksakaew</name><affiliation><nlm:aff id="A1">HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand</nlm:aff></affiliation></author><author><name sortKey="Suwarnlerk, Tulathip" sort="Suwarnlerk, Tulathip" uniqKey="Suwarnlerk T" first="Tulathip" last="Suwarnlerk">Tulathip Suwarnlerk</name><affiliation><nlm:aff id="A1">HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand</nlm:aff></affiliation></author><author><name sortKey="Apornpong, Tanakorn" sort="Apornpong, Tanakorn" uniqKey="Apornpong T" first="Tanakorn" last="Apornpong">Tanakorn Apornpong</name><affiliation><nlm:aff id="A1">HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand</nlm:aff></affiliation></author><author><name sortKey="Ratanadilok, Kattiya" sort="Ratanadilok, Kattiya" uniqKey="Ratanadilok K" first="Kattiya" last="Ratanadilok">Kattiya Ratanadilok</name><affiliation><nlm:aff id="A15">Department of Juvenile Observation and Protection, Ministry of Justice, Thailand</nlm:aff></affiliation></author><author><name sortKey="Paul, Robert" sort="Paul, Robert" uniqKey="Paul R" first="Robert" last="Paul">Robert Paul</name><affiliation><nlm:aff id="A16">Department of Psychology, University of Missouri, St. Louis, MO, USA</nlm:aff></affiliation></author><author><name sortKey="Mofenson, Lynne M" sort="Mofenson, Lynne M" uniqKey="Mofenson L" first="Lynne M." last="Mofenson">Lynne M. Mofenson</name><affiliation><nlm:aff id="A17"><italic>Eunice Kennedy Shriver</italic> National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA</nlm:aff></affiliation></author><author><name sortKey="Fox, Lawrence" sort="Fox, Lawrence" uniqKey="Fox L" first="Lawrence" last="Fox">Lawrence Fox</name><affiliation><nlm:aff id="A18">Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA</nlm:aff></affiliation></author><author><name sortKey="Valcour, Victor" sort="Valcour, Victor" uniqKey="Valcour V" first="Victor" last="Valcour">Victor Valcour</name><affiliation><nlm:aff id="A4">SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand</nlm:aff></affiliation><affiliation><nlm:aff id="A19">Memory and Aging Center, University of California at San Francisco, CA, USA</nlm:aff></affiliation></author><author><name sortKey="Brouwers, Pim" sort="Brouwers, Pim" uniqKey="Brouwers P" first="Pim" last="Brouwers">Pim Brouwers</name><affiliation><nlm:aff id="A20">National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA</nlm:aff></affiliation></author><author><name sortKey="Ruxrungtham, Kiat" sort="Ruxrungtham, Kiat" uniqKey="Ruxrungtham K" first="Kiat" last="Ruxrungtham">Kiat Ruxrungtham</name><affiliation><nlm:aff id="A1">HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand</nlm:aff></affiliation><affiliation><nlm:aff id="A3">Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand</nlm:aff></affiliation></author></analytic><series><title level="j">The Pediatric infectious disease journal</title><idno type="ISSN">0891-3668</idno><idno type="eISSN">1532-0987</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title><p id="P1">We previously reported similar AIDS-free survival at 3 years in children who were >1 year old initiating antiretroviral therapy (ART) and randomized to early vs. deferred ART in the PREDICT Study. We now report neurodevelopmental outcomes.</p></sec><sec id="S2"><title>Methods</title><p id="P2">284 HIV-infected Thai and Cambodian children aged 1–12 years with CD4 counts between 15–24% and no AIDS-defining illness were randomized to initiate ART at enrollment (“early”, n=139) or when CD4 count became <15% or a CDC C event developed (“deferred”, n=145). All underwent age-appropriate neurodevelopment testing including Beery Visual Motor Integration (VMI), Purdue Pegboard, Color Trails and Child Behavioral Checklist (CBCL). Thai children (n=170) also completed Wechsler Intelligence Scale (IQ) and Stanford Binet Memory test. We compared week 144 measures by randomized group and to HIV-uninfected children (n=319).</p></sec><sec id="S3"><title>Results</title><p id="P3">At week 144, the median age was 9 years and 69 (48%) of the deferred arm children had initiated ART. The early arm had a higher CD4 (33% vs. 24%, p<0.001) and a greater percentage of children with viral suppression (91% vs. 40%, p<0.001). Neurodevelopmental scores did not differ by arm and there were no differences in changes between arms across repeated assessments in time-varying multivariate models. HIV-infected children performed worse than uninfected children on IQ, Beery VMI, Binet memory and CBCL</p></sec><sec id="S4"><title>Conclusions</title><p id="P4">In HIV-infected children surviving beyond one year of age without ART, neurodevelopmental outcomes were similar with ART initiation at CD4 15–24% vs. < 15%; but both groups performed worse than HIV-uninfected children. The window of opportunity for a positive effect of ART initiation on neurodevelopment may remain in infancy.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">8701858</journal-id><journal-id journal-id-type="pubmed-jr-id">6404</journal-id><journal-id journal-id-type="nlm-ta">Pediatr Infect Dis J</journal-id><journal-id journal-id-type="iso-abbrev">Pediatr. Infect. Dis. J.</journal-id><journal-title-group><journal-title>The Pediatric infectious disease journal</journal-title></journal-title-group><issn pub-type="ppub">0891-3668</issn><issn pub-type="epub">1532-0987</issn></journal-meta><article-meta><article-id pub-id-type="pmid">23263176</article-id><article-id pub-id-type="pmc">3664246</article-id><article-id pub-id-type="doi">10.1097/INF.0b013e31827fb19d</article-id><article-id pub-id-type="manuscript">NIHMS431708</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Cognitive Function and Neurodevelopmental Outcomes in HIV-Infected Children Older than 1 Year of Age Randomized to Early Versus Deferred Antiretroviral Therapy: The PREDICT Neurodevelopmental Study</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Puthanakit</surname><given-names>Thanyawee</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Ananworanich</surname><given-names>Jintanat</given-names></name><degrees>MD, PhD</degrees><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A3">3</xref><xref ref-type="aff" rid="A4">4</xref><xref ref-type="aff" rid="A8">8</xref><xref ref-type="aff" rid="A9">9</xref></contrib><contrib contrib-type="author"><name><surname>Vonthanak</surname><given-names>Saphonn</given-names></name><degrees>MD, PhD</degrees><xref ref-type="aff" rid="A5">5</xref></contrib><contrib contrib-type="author"><name><surname>Kosalaraksa</surname><given-names>Pope</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A6">6</xref></contrib><contrib contrib-type="author"><name><surname>Hansudewechakul</surname><given-names>Rawiwan</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A7">7</xref></contrib><contrib contrib-type="author"><name><surname>van der Lugt</surname><given-names>Jasper</given-names></name><degrees>MD, PhD</degrees><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A8">8</xref></contrib><contrib contrib-type="author"><name><surname>Kerr</surname><given-names>Stephen J.</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A9">9</xref></contrib><contrib contrib-type="author"><name><surname>Kanjanavanit</surname><given-names>Suparat</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A10">10</xref></contrib><contrib contrib-type="author"><name><surname>Ngampiyaskul</surname><given-names>Chaiwat</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A11">11</xref></contrib><contrib contrib-type="author"><name><surname>Wongsawat</surname><given-names>Jurai</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A12">12</xref></contrib><contrib contrib-type="author"><name><surname>Luesomboon</surname><given-names>Wicharn</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A13">13</xref></contrib><contrib contrib-type="author"><name><surname>Vibol</surname><given-names>Ung</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A14">14</xref></contrib><contrib contrib-type="author"><name><surname>Pruksakaew</surname><given-names>Kanchana</given-names></name><degrees>BSc</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Suwarnlerk</surname><given-names>Tulathip</given-names></name><degrees>BNS</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Apornpong</surname><given-names>Tanakorn</given-names></name><degrees>MSc</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Ratanadilok</surname><given-names>Kattiya</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="A15">15</xref></contrib><contrib contrib-type="author"><name><surname>Paul</surname><given-names>Robert</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="A16">16</xref></contrib><contrib contrib-type="author"><name><surname>Mofenson</surname><given-names>Lynne M.</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A17">17</xref></contrib><contrib contrib-type="author"><name><surname>Fox</surname><given-names>Lawrence</given-names></name><degrees>MD, PhD</degrees><xref ref-type="aff" rid="A18">18</xref></contrib><contrib contrib-type="author"><name><surname>Valcour</surname><given-names>Victor</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A4">4</xref><xref ref-type="aff" rid="A19">19</xref></contrib><contrib contrib-type="author"><name><surname>Brouwers</surname><given-names>Pim</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="A20">20</xref></contrib><contrib contrib-type="author"><name><surname>Ruxrungtham</surname><given-names>Kiat</given-names></name><degrees>MD, MSc</degrees><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><collab>on behalf of the PREDICT Study Group</collab></contrib></contrib-group><aff id="A1"><label>1</label>HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand</aff><aff id="A2"><label>2</label>Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand</aff><aff id="A3"><label>3</label>Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand</aff><aff id="A4"><label>4</label>SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand</aff><aff id="A5"><label>5</label>National Center for HIV/AIDS Dermatology and STDs, Phnom Penh, Cambodia</aff><aff id="A6"><label>6</label>Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand</aff><aff id="A7"><label>7</label>Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand</aff><aff id="A8"><label>8</label>The Amsterdam Institute of Global Health and Development, Amsterdam, The Netherlands</aff><aff id="A9"><label>9</label>The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW, Australia</aff><aff id="A10"><label>10</label>Nakornping Hospital, Chiang Mai, Thailand</aff><aff id="A11"><label>11</label>Prapokklao Hospital, Chantaburi, Thailand</aff><aff id="A12"><label>12</label>Bamrasnaradura Infectious Diseases Institute, Nonthaburi, Thailand</aff><aff id="A13"><label>13</label>Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand</aff><aff id="A14"><label>14</label>National Pediatric Hospital, Phnom Penh, Cambodia</aff><aff id="A15"><label>15</label>Department of Juvenile Observation and Protection, Ministry of Justice, Thailand</aff><aff id="A16"><label>16</label>Department of Psychology, University of Missouri, St. Louis, MO, USA</aff><aff id="A17"><label>17</label><italic>Eunice Kennedy Shriver</italic> National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA</aff><aff id="A18"><label>18</label>Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA</aff><aff id="A19"><label>19</label>Memory and Aging Center, University of California at San Francisco, CA, USA</aff><aff id="A20"><label>20</label>National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA</aff><author-notes><corresp id="cor1"><bold>Corresponding author:</bold> Jintanat Ananworanich, MD, PhD. HIV-NAT, The Thai Red Cross AIDS Research Center, 104 Rajdumri Road, Pathumwan, Bangkok 10330 Thailand. Phone +66 255 7335. Fax +66 2 252 5779. <email>Jintanat.A@hivnat.org</email></corresp></author-notes><pub-date pub-type="nihms-submitted"><day>23</day><month>1</month><year>2013</year></pub-date><pub-date pub-type="ppub"><month>5</month><year>2013</year></pub-date><pub-date pub-type="pmc-release"><day>01</day><month>5</month><year>2014</year></pub-date><volume>32</volume><issue>5</issue><fpage>501</fpage><lpage>508</lpage><abstract><sec id="S1"><title>Background</title><p id="P1">We previously reported similar AIDS-free survival at 3 years in children who were >1 year old initiating antiretroviral therapy (ART) and randomized to early vs. deferred ART in the PREDICT Study. We now report neurodevelopmental outcomes.</p></sec><sec id="S2"><title>Methods</title><p id="P2">284 HIV-infected Thai and Cambodian children aged 1–12 years with CD4 counts between 15–24% and no AIDS-defining illness were randomized to initiate ART at enrollment (“early”, n=139) or when CD4 count became <15% or a CDC C event developed (“deferred”, n=145). All underwent age-appropriate neurodevelopment testing including Beery Visual Motor Integration (VMI), Purdue Pegboard, Color Trails and Child Behavioral Checklist (CBCL). Thai children (n=170) also completed Wechsler Intelligence Scale (IQ) and Stanford Binet Memory test. We compared week 144 measures by randomized group and to HIV-uninfected children (n=319).</p></sec><sec id="S3"><title>Results</title><p id="P3">At week 144, the median age was 9 years and 69 (48%) of the deferred arm children had initiated ART. The early arm had a higher CD4 (33% vs. 24%, p<0.001) and a greater percentage of children with viral suppression (91% vs. 40%, p<0.001). Neurodevelopmental scores did not differ by arm and there were no differences in changes between arms across repeated assessments in time-varying multivariate models. HIV-infected children performed worse than uninfected children on IQ, Beery VMI, Binet memory and CBCL</p></sec><sec id="S4"><title>Conclusions</title><p id="P4">In HIV-infected children surviving beyond one year of age without ART, neurodevelopmental outcomes were similar with ART initiation at CD4 15–24% vs. < 15%; but both groups performed worse than HIV-uninfected children. The window of opportunity for a positive effect of ART initiation on neurodevelopment may remain in infancy.</p></sec></abstract><kwd-group><kwd>HIV</kwd><kwd>Children</kwd><kwd>ART</kwd><kwd>neurodevelopment</kwd><kwd>resource-limited settings</kwd></kwd-group><funding-group><award-group><funding-source country="United States">National Institute of Allergy and Infectious Diseases Extramural Activities : NIAID</funding-source><award-id>U19 AI053741 || AI</award-id></award-group></funding-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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