Although earlier studies do not report ART use (Pavlakis et al., 1995; Lu et al., 1996), basal ganglia neurometabolite alterations reported subsequently were observed even in HIV+ children on ART (Keller et al., 2004; Gabis et al., 2006; Ashby et al., 2015; Mbugua et al., 2016). However, these studies used relatively small sample sizes (between 8 and 45 HIV+ subjects) spanning a wide age range and starting ART at varying stages of childhood. One study examined basal ganglia neurometabolites in young children who all initiated ART before 18 months of age (Mbugua et al., 2016). In that study, lower CD4/CD8 ratio at enrollment, aged 6–8 weeks, was associated with lower basal ganglia NAA and Cho at age 5 years, despite early ART initiation and viral load suppression.