Neurodevelopmental delay in children infected with human immunodeficiency virus in Soweto, South Africa

HIV in children is a serious and growing problem in sub-Saharan Africa. At present very little is known about the neurological complications of human immunodeficiency virus (HIV)-infected children in South Africa. The aim of this study was to determine the extent and prevalence of neurodevelopmental delay in a group of HIV-positive children in Soweto, South Africa, as well as to determine what factors were predictive of neurodevelopmental delay. One hundred and twenty-two consecutive HIV-positive children under 2.5 years of age were assessed using the Bayley Scales of Infant Development II. Ethical approval and informed consent were obtained prior to testing. The children assessed in this study were extremely delayed in both motor and cognitive development. Seventy-two per cent of the children had severe motor delay and 52% had severe cognitive delay. The mean age of the children was 18.5 months (±8.1). The mean CD4 count was 14.4% (±8.8) and only 16% of the children were receiving highly active antiretroviral therapy (HAART). Weight, height and head circumference Z-scores were also very low in this group of children, with both stunting and wasting being extremely common. Neurodevelopmental delay was very common in this group of children. Motor development was affected more severely than cognitive development. Weight-for-age, age and whether the child was on HAART were the most important factors in predicting cognitive and motor development. Poverty and poor socioeconomic status of families of HIV-infected children may well be additional developmental risk factors.