Background
The health of uninfected children exposed to HIV requires long-term assessment, in particular, in terms of neurological and cognitive development. Numerous confounding factors have hampered such assessment, and the data are contradictory.
Methods
Using data from the French National Health Data System from 2012 to 2022, we conducted a population-based matched cohort study on all live-single born children including children born to HIV-infected mothers, all prenatally exposed to antiretrovirals (ARV). The primary outcome was the diagnosis of neurodevelopmental disorders according to the 2010 International Classification of Diseases. The recourse to specialized consultations likely to indirectly reflect neurodevelopmental symptoms was also evaluated. Incidence was assessed using the Cox survival model.
Results
Of 6,667 363 live-born singletons, 9,035 were born to mothers living with HIV, all exposed to ARV during pregnancy. Children were followed up to 11 years, for an average of 5.5 yrs. Overall, the incidence of neurodevelopmental disorders among exposed children was higher than in the general population, even after matching for five sociodemographic criteria (zip code, social vulnerability indicator, salary, maternal age, year of birth) and gestational age, HR [95%CI]: 1.24 [1.04 – 1.47]. It was not possible to dissect the respective role of maternal infection from that of maternal treatment, as all children were co-exposed to HIV and ARV. However, among those exposed to tenofovir-emtricitabine, the r-darunavir-based combination was significantly associated with a higher combined incidence of neurodevelopmental disorders and related specialized consultations than other protease inhibitors (log rank, p<0.001).
Conclusions
Children exposed in utero to ARV and HIV are at higher risk of neurodevelopmental disorders of multifactorial origin.
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