Utero antiretroviral exposure and sociodemographic characteristics on neurodevelopment of HIV‐exposed uninfected children vs. HIV‐unexposed uninfected healthy children in Malawi

Background We aimed to evaluate mental development index (MDI) and psychomotor development index (PDI) of HIV-exposed uninfected (HEU) children by timing of in-utero antiretroviral treatment (ART) initiation (Option B+) and sociodemographic characteristics compared to HIV-unexposed uninfected (HUU) children in Mzuzu, Malawi. Method 100 HEU children and 100 HUU children aged 2-30 months were recruited. The difference of MDI and PDI scores between HEU and HUU children was tested by student's t-test, ANOVA, Mann-Whitney U test and logistic regression analysis. Results The difference of MDI and PDI scores might be related to number of family children, delivery, place of residence, family income, complementary feeding, father' or mother's occupation and degree of education. No significant difference of MDI and PDI scores between HEU and HUU children (p = 0.076 and p = 0.407). Among HEU children, ART in 3rd trimester and beyond had lower PDI score compared to ART before pregnancy and 1st or 2nd trimester (p = 0.027). Conclusion Our findings provided that MDI and PDI scores of HEU subgroups with different timing of ART (Option B+) initiation was comparable to HUU group. Early in-utero ART initiation was associated with better neurodevelopment outcomes than ART initiation in 3rd trimester and beyond.