# The Role of Iron Deficiency in the Neurodevelopment of Children Perinatally Exposed to HIV

> **NIH NIH R21** · UNIVERSITY OF MINNESOTA · 2020 · $153,162

## Abstract

ABSTRACT
With antiretroviral therapy (ART) increasingly available in pregnancy and childhood in sub-Saharan African
countries where human immunodeficiency virus (HIV) is most prevalent, both the number of children who are
HIV-infected (HI) but reaching adulthood and the number of children exposed to HIV but uninfected themselves
(HEU) are increasing, shifting the post-ART research agenda to improving the quality of life in children
perinatally exposed to HIV. Both HI children established on ART and HEU children have persistent
neurobehavioral (NB) deficits in the areas of global cognition, executive functioning, motor development, but
the mechanism of this delay is unclear. Iron deficiency (ID) afflicts 30% of children younger than 59 months in
sub-Saharan Africa and is an established cause of impaired child brain development, but to date, no study has
examined a potential association for ID in the NB impairments described in children perinatally exposed to HIV.
Building on existing collaboration and substantial multidisciplinary expertise, we will characterize iron status
and determine the prevalence of ID in a cohort of HI (n=70), HEU (n=70), and HIV-unexposed, uninfected
(HUU) children (n=70) (Aim 1) who attend the Joint Research Centre in Kampala, Uganda, and we will
establish the relationship between ID and scores from a range of NB tests (Aim 2) that collectively assess
global cognition, motor development, executive function, and behavior. Notably, our study will be the first to
apply the Behavior Rating Scales, a test for deficits in socioemotional behavior that are secondary to the
altered dopaminergic signaling in an iron-deficient brain, in the context of HIV. We hypothesize that HEU and
HI children will have a higher prevalence of ID (soluble transferrin receptor > 8.3 mg/L) and poorer NB test
scores than HUU children and that within each group, scores will be poorer in ID vs. non-ID children. However,
this difference will be greater in HEU and HI than in HUU children. This pilot and feasibility study will
demonstrate whether there is an association between childhood ID and NB deficits in HI and HEU children,
while also establishing the capacity and intellectual infrastructure to carry out NB assessments at JCRC for
future longitudinal studies that can establish the temporality of iron deficiency and other factors that may lead
to NB deficits in the sizeable and growing group of children perinatally exposed to HIV.

## Key facts

- **NIH application ID:** 10001583
- **Project number:** 5R21HD099779-02
- **Recipient organization:** UNIVERSITY OF MINNESOTA
- **Principal Investigator:** Sarah Cusick
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $153,162
- **Award type:** 5
- **Project period:** 2019-09-01 → 2022-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10001583

## Citation

> US National Institutes of Health, RePORTER application 10001583, The Role of Iron Deficiency in the Neurodevelopment of Children Perinatally Exposed to HIV (5R21HD099779-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10001583. Licensed CC0.

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