# Neurocognitive development of HIV-exposed and uninfected infants in Malawi

> **NIH NIH R01** · UNIVERSITY OF MARYLAND BALTIMORE · 2022 · $596,576

## Abstract

PROJECT SUMMARY
Every year, over a million children who are HIV-exposed but uninfected (CHEU) are born in sub-Saharan Africa
and this population will continue to increase with improving availability of antiretroviral therapy (ART). In utero
HIV exposure has broad ranging health impacts and emerging data suggest that CHEU have higher risk of
neurocognitive delay compared to unexposed children. But the contribution of biological factors, the psychosocial
environment and maternal-child interactions to this delay remains poorly characterized. This proposal will take
advantage of the unique opportunity to evaluate the impact of in utero HIV exposure on neurocognitive
development in children in the context of an ongoing clinical study we are conducting in Malawi. We are screening
pregnant women, enrolling infants and conducting immunological analysis of neonatal adaptive immunity in three
categories: (1) CHEU born to women diagnosed with HIV at the first antenatal visit, thus exposed to uncontrolled
viremia for at least half of gestation; (2) CHEU born to women initiated on ART prior to conception with
undetectable viral loads; and (3) infants born to HIV uninfected mothers. We collect cord blood mononuclear
cells at birth to conduct a detailed immunological analysis. In this proposal, we will increase our sample size,
incorporate assessment of monocyte activation from cord blood specimens and extend follow up of these infants
to five years of age. Our goal is to conduct rigorously validated longitudinal assessments of neurocognitive
development and psychosocial factors including maternal mental health, socioeconomic status, HIV stigma,
home environment and mother-child interactions. Our interdisciplinary study team of infectious disease
specialists, developmental pediatricians, social scientists and immunologists will lead one of the first studies of
CHEU in resource-limited settings to simultaneously address the impact of biological and psychosocial factors
on neurocognitive development. We hypothesize that in utero exposure to HIV will impair neurocognitive
development in the first five years of life and children born to HIV-infected mothers with untreated HIV infection
at the start of pregnancy will demonstrate more delay than children of mothers with undetectable HIV viral load
throughout pregnancy. We further hypothesize that both immunological status at birth and psychosocial factors
will contribute to impaired neurocognitive development in CHEU. This study will provide detailed evidence to
develop interventions to improve the well-being of CHEU in resource-limited settings.

## Key facts

- **NIH application ID:** 10424474
- **Project number:** 5R01HD100235-03
- **Recipient organization:** UNIVERSITY OF MARYLAND BALTIMORE
- **Principal Investigator:** Melissa Gladstone
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $596,576
- **Award type:** 5
- **Project period:** 2020-08-01 → 2025-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10424474

## Citation

> US National Institutes of Health, RePORTER application 10424474, Neurocognitive development of HIV-exposed and uninfected infants in Malawi (5R01HD100235-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10424474. Licensed CC0.

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