Risk for Speech and Language Impairments in Pre-school Aged HIV-Exposed Uninfected Children with in utero Combination Antiretroviral Exposure

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Perinatally HIV-exposed but uninfected (HEU) children have elevated risk of late language emergence at age 1 year, with possible links to in utero antiretroviral (ARV) exposure. We investigated possible risks for speech impairments (SI) and language impairments (LI) in preschool monolingual HEU children in the United States.


Speech and language assessments were conducted as part of the PHACS Surveillance Monitoring of ART Toxicities (SMARTT) study at ages 3 (N= 208) and 5 (N = 429) years. Domains of speech, overall language, vocabulary and grammar were assessed. SI and LI were defined by standardized scores (SCs) <15th percentile and categorized as primary (normal nonverbal IQ ≥ 85 without hearing loss) and concomitant (low nonverbal IQ and/or presence of hearing loss). Logistic regression models were used to estimate odds of SI and LI for different ARV exposures, adjusted for confounding variables.


The risk for language impairments in HEU children was higher than population norms; risk for speech impairments was not elevated. Risk factors for impairments included male sex, black race, and other socioeconomic measures, although these varied by age, primary (P) vs. concomitant (C) impairment, and by speech or language measure. Adjusted logistic regression models revealed lower as well as increased risk for specific ARVs. Tenofovir exposure was associated with increased risk for SI at age 3 but was associated with decreased risk for CLI at age 5.


Further investigation of cARV exposure and speech/language impairment among pre-school children is needed to confirm associations.

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