Developmental outcomes of HIV-exposed infants in a low-income South African context

Background: Effective HIV transmission prevention strategies have led to a growing population of vulnerable HIV-and antiretroviral-exposed infants in sub-Saharan Africa, however uncertainty exists regarding their development. Objective: To determine the developmental outcomes of HIV-exposed (HE) infants in a low-income South African context, when compared to HIV-unexposed (HU) counterparts. Methods: In this prospective cross-sectional, group comparison study, the development of 41 HE and 40 HU infants (mean age=8.4 months, SD=2.1 months) from a low-income context was assessed. Caregivers were interviewed using the Vineland Adaptive Behavior Scales, Third Edition (Vineland-3) to evaluate infants' development. Results: Most HE participants had age-appropriate overall development (90.2%;n=37). Some HE participants, however, presented with delays in domains of communication (9.8%;n=4), daily living skills (2.4%;n=1), socialisation (19.5%;n=8), and motor development (7.3%;n=3). HU participants also demonstrated some domain-specific delays, thus delays were present in both groups. No statistically significant between-group differences regarding development were found. Conclusion: Findings were reassuring and suggested that HE and HU participants had similar development. Developmental differences may, however, only emerge with age, therefore large-scale longitudinal research is recommended. It is suggested that the entire sample was vulnerable, highlighting the importance of developmental surveillance in low-income contexts, irrespective of HIV and antiretroviral exposure status.