Surprisingly, at age 9 we detect reductions in several neurometabolites in HEU children relative to controls. Notably, regression coefficients for NAA, Glu, and Cr suggest larger reductions in HEU than HIV+ children, and a reduction in Cho is seen relative to controls in HEU but not HIV+ children. Although few neuroimaging studies have been done in HEU children, one diffusion tensor imaging (DTI) study in infants identified a region with high fractional anisotropy in the cerebellum (Tran et al., 2016) and another did not detect DTI or brain volume differences between HEU and control children (Jahanshad et al., 2015). Ours is the first to demonstrate neurometabolite alterations related to HIV/ART exposure. One previous study found elevated white matter Cho/Cr and NAA/Cr ratios in neonates exposed to HIV and ART in utero, however, the HIV status of these infants was not determined (Cortey et al., 1994).