***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives . To compare language development in infants and young children with human immunodeficiency virus ( HIV ) infection to language development in children who had been exposed to HIV but were uninfected , and ( among subjects with HIV infection ) to compare language development with cognitive and neurologic status . Design . Prospect i ve evaluation of language development in infected and in exposed but uninfected infants and young children . Setting . Pediatric Infectious Disease Clinic , State University of New York – Health Science Center at Syracuse . Subjects . Nine infants and young children infected with HIV and 69 seropositive but uninfected infants and children , age 6 weeks to 45 months . Results . Mean Early Language Milestone Scale , 2nd edition ( ELM-2 ) Global Language scores were significantly lower for subjects with HIV infection , compared with uninfected subjects ( 89.3 vs 96.2 , Mann – Whitney U test ) . The proportion of subjects scoring > 2 SD below the mean on the ELM-2 on at least one occasion also was significantly greater for subjects with HIV infection , compared with uninfected subjects ( 4 of 9 infected subjects , but only 5 of 69 uninfected subjects ; Fisher 's exact test ) . Seven of the 9 subjects with HIV infection manifested deterioration of language function . Four manifested unremitting deterioration ; only 1 of these 4 demonstrated unequivocal abnormality on neurologic examination . Three subjects with HIV infection and language deterioration showed improvement in language almost immediately after the initiation of antiretroviral drug treatment . Magnetic resonance imaging or computed tomography of the brain were performed in 6 of 7 infected subjects with language deterioration , and findings were normal in all 6 . ELM-2 Global Language scaled scores showed good agreement with the Bayley Mental Developmental Index or the McCarthy Global Cognitive Index ( r = 0.70 ) . Language deterioration , or improvement in language after initiation of drug therapy , coincided with or preceded changes in global cognitive function , at times by intervals of up to 12 months . Conclusions . Language deterioration occurs commonly in infants and young children with HIV infection , is seen frequently in the absence of abnormalities on neurologic examination or central nervous system imaging , and may precede evidence of deterioration in global cognitive ability . Periodic assessment of language development should be added to the developmental monitoring of infants and young children with HIV infection as a means of monitoring disease progression and the efficacy of drug treatment BACKGROUND The neurodevelopmental outcomes of human immunodeficiency virus type 1 (HIV-1)-infected Ug and an infants of nondrug-using mothers were studied using controlled , prospect i ve methodology . METHOD The sample of 436 full-term infants included 79 HIV-infected infants of HIV-1-infected mothers , 241 uninfected infants of HIV-1-infected mothers ( seroreverters ) , and 116 uninfected infants born to HIV-negative mothers .  Neurologic status , information processing ability , and motor and mental development were assessed from 6 to 24 months of age . Observations of caretaker-child interaction and home environments were made at 6 and 12 months . All evaluators were blinded to the HIV status of the child and family . RESULTS Compared with seroreverters and uninfected infants , HIV-infected infants demonstrated greater deficits in motor development and neurologic status , and more frequent and earlier onset of motor and neurologic abnormalities . Compared with controls , HIV-infected infants had more abnormalities in mental development at 6 and 18 months and an earlier onset of abnormalities . By 12 months , 30 % of HIV-infected infants demonstrated motor abnormalities and 26 % cognitive abnormalities as compared with 11 % and 6 % among seroreverters and 5 % and 6 % among seronegative infants . HIV-infected infants ( 62 % ) demonstrated a higher probability of developing an abnormal neurologic examination by 12 months , compared with seroreverters ( 17 % ) or seronegative infants ( 15 % ) . Information-processing abilities did not differ as a function of HIV infection . Home environments and infants ' interactions with caretakers were similar across groups . CONCLUSION We conclude that HIV infection results in more frequent and earlier abnormalities in infants ' neurologic status and motor development that are not attributable to other biological and environmental risk factors . More frequent mental developmental abnormalities were evident at several ages . However , information-processing abilities , such as recognition memory , may be spared from HIV-related deficits Objective . To examine the frequency , timing , and factors associated with abnormal cognitive and motor development during the first 30 months of life in infants born to women infected with human immunodeficiency virus type 1 ( HIV-1 ) . Methods . Serial neurodevelopmental assessment was performed with 595 infants born to women infected with HIV-1 in a multicenter , prospect i ve , natural history cohort study .  Survival analysis methods were used to evaluate 6 outcome events related to abnormal cognitive and motor growth ( time to confirmed drop of 1 SD , time to first score < 69 , and time to confirmed drop of 2 SD ) in Bayley Scales of Infant Development Mental Developmental Index ( MDI ) and Psychomotor Developmental Index ( PDI ) scores among infected ( n = 114 ) and uninfected ( n = 481 ) infants . Proportional hazards modeling was used to evaluate the effects of HIV infection status , prematurity , prenatal exposure to illicit drugs , maternal educational attainment , and primary language . Results . HIV-1 infection was significantly associated with increased risk for all outcome events related to abnormal mental and motor growth . Differences between infected and uninfected infants were apparent by 4 months of age . Prematurity was associated with increased risk for MDI < 69 and PDI < 69 . Maternal education of < 9 completed years was associated with increased risk for MDI < 69 . Neither prenatal exposure to illicit drugs nor primary language other than English was associated with abnormal development . Conclusion . A significant proportion of infants with HIV-1 infection show early and marked cognitive and motor delays or declines that may be important early indicators of HIV disease progression . These abnormalities are independent of other risk factors for developmental delay BACKGROUND HIV contributes substantially to child mortality , but factors underlying these deaths are inadequately described . With individual data from seven r and omised mother-to-child transmission ( MTCT ) intervention trials , we estimate mortality in African children born to HIV-infected mothers and analyse selected risk factors . METHODS Early HIV infection was defined as a positive HIV-PCR test before 4 weeks of age ; and late infection by a negative PCR test at or after 4 weeks of age , followed by a positive test . Mortality rate was expressed per 1000 child-years . We investigated the effect of maternal health , infant HIV infection , feeding practice s , and age at acquisition of infection on mortality assessed with Cox proportional hazards models , and allowed for r and om effects for trials grouped geographically . FINDINGS 378 ( 11 % ) of 3468 children  died . By age 1 year , an estimated 35.2 % infected and 4.9 % uninfected children will have died ; by 2 years of age , 52.5 % and 7.6 % will have died , respectively . Mortality varied by geographical region , and was associated with maternal death ( adjusted odds ratio 2.27 , 95 % CI 1.62 - 3.19 ) , CD4 + cell counts < 200 per microL ( 1.91 , 1.39 - 2.62 ) , and infant HIV infection ( 8.16 , 6.43 - 10.33 ) . Mortality was not associated with either ever breastfeeding and never breastfeeding in either infected or uninfected children . In infected children , mortality was significantly lower for those with late infection than those with early infection ( 0.52 , 0.39 - 0.70 ) . This effect was also seen in analyses of survival from the age at infection ( 0.74 , 0.55 - 0.99 ) . INTERPRETATION These findings highlight the necessity for timely antiretroviral care , for support for HIV-infected women and children in developing countries , and for assessment of prophylactic programmes to prevent MTCT , including child mortality and infection averted BACKGROUND Combination therapy including protease inhibitors has been shown to be effective in treating adults infected with human immunodeficiency virus type 1 ( HIV-1 ) , but there are only limited data regarding the treatment of children and adolescents . METHODS A cohort of 1028 HIV-1-infected children and adolescents , from birth through 20 years of age , who were enrolled in research clinics in the United States before 1996 was followed prospect ively through 1999 . We used proportional-hazards regression models to estimate the effect on mortality of combination therapy including protease inhibitors . RESULTS Seven percent of the subjects were receiving combination therapy including protease inhibitors in 1996 ; by 1999 , 73 percent were receiving such therapy . In univariate analyses , a higher base-line percentage of lymphocytes that were CD4-positive , a higher weight for age , a higher height for age , black race , Hispanic ethnic background , younger age , and perinatally acquired infection were associated with a longer median time to the initiation of this type of therapy ( P<0.001 ) . After adjustment for covariates , the differences among racial and ethnic groups in the time to initiation were not statistically significant . Mortality declined from 5.3 percent in 1996 to 2.1 percent in 1997 , 0.9 percent in 1998 , and 0.7 percent in 1999 ( P for trend < 0.001 ) . There were reductions in mortality in all subgroups defined according to age , sex , percentage of CD4 + lymphocytes , educational level of the parent or guardian , and race or ethnic background . In adjusted analyses , the initiation of combination therapy including protease inhibitors was independently associated with reduced mortality ( hazard ratio for death , 0.33 ; 95 percent confidence interval , 0.19 to 0.58 ; P<0.001 ) . CONCLUSIONS The use of combination therapy including protease inhibitors has markedly reduced mortality among children and adolescents infected with HIV-1 Neurodevelopmental outcomes of human immunodeficiency virus Type 1 (HIV-1)-infected infants of non-drug-using mothers were assessed in a controlled , prospect i ve study from birth to 24 months with 3 groups : 61 infants of HIV-infected mothers , 234 uninfected infants of HIV-infected mothers ( seroreverters ) , and 115 uninfected infants of uninfected mothers . Compared with seroreverters and uninfected infants , HIV-infected infants demonstrated lower mental and motor development on the Bayley Scales and greater deceleration in their rate of motor development .  HIV-infected infants with abnormal neurologic exams had lower motor and mental test scores and lower rates of motor Bayley Scales scores than their HIV-infected counterparts with normal neurologic exams . Contrary to prediction , no group differences in mean performance or growth rates were found on visual information processing on the Fagan Test of Infant Intelligence OBJECTIVE . The purpose of this study was to assess the health status and school-age neurodevelopmental progress of  antiretroviral treatment (ARVT)–naive , HIV-infected Ug and an children who had been followed as part of cohorts of children born to HIV-infected and -noninfected mothers between 1989 and 1993 . METHODS . Twenty-eight children , aged 6 to 12 years , vertically infected with HIV-1 and never treated with ARVT  were evaluated in terms of health status , neurologic , and psychometric testing . A r and omly selected group of 42 seroreverters and 37 HIV-1 negative children who were age- and gender-matched and who had been followed in the same cohorts were evaluated also . The families studied were homogenous in their socioeconomic status . None of the mothers or children had received ARVT or been exposed to illicit drugs . RESULTS . The HIV-infected children showed significantly more evidence of acute malnutrition . They also had more illness , especially parotitis , otitis media , upper respiratory infections , and lymphadenopathy . However , they did not differ significantly in neurologic and cognitive assessment s when compared with age- and gender-matched seroreverter and HIV-negative children . They were in the normal range with respect to neurologic and psychometric development measures . CONCLUSIONS .These children seem to represent a significant subgroup of HIV-infected child survivors for whom the progress of the disease is less aggressive throughout early life . Given the fact that many infants , especially in developing countries , continue to be born without the benefit of perinatal ARVT , there will likely continue to be many older HIV-infected children in the same situation as those described in this follow-up study . They will not have been recognized as being HIV-infected . It is important that such children be identified and offered access to ARVT and other appropriate support services 
    Output:
    
Although HIV has been shown to affect all domains of child functioning , motor development is the most apparent in terms of severity , early onset , and persistence across age groups .