Similarly, studies of school-aged HEU children demonstrate subtle deficits compared to control children, particularly in language-related cognitive performance (Van Rie et al., 2008; Kerr et al., 2014; Milligan and Cockcroft, 2017). A recent longitudinal study reported that neurodevelopment of HEU children is initially similar to their HIV-unexposed peers, but neurocognitive performance starts to fall behind that of HIV-unexposed children during childhood (Smith et al., 2017). This might correspond to a lack of normal age-related increase in Cho, Glu, and NAA in the basal ganglia during childhood (Holmes et al., 2017), which could explain our observations of reduced levels relative to control children at age 9.