Assessing the combined impact of pesticide exposure and HIV/ART on child neurodevelopment in Eastern and Southern Africa: a systematic review

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BACKGROUND: Environmental exposures, particularly pesticides, have been implicated in neurodevelopmental disorders (NDDs). Additionally, children who are HIV-exposed but uninfected (HEU) are at increased risk of neurodevelopmental delays. However, there is limited research exploring the combined effects of HIV/antiretroviral therapy (ART) exposure and pesticide exposure, especially in children from agricultural communities in Southern and Eastern Africa. This systematic review investigates the potential impact of pesticide exposure on neurodevelopmental outcomes in HEU children from these regions. METHODS: A systematic review methodology was employed, following PRISMA guidelines. Studies published between 2008 and July 2024 were retrieved from databases including PubMed, Scopus, Embase, AJOL, conference proceedings, and grey literature. The review focused on children born to smallholder horticultural farmers exposed to both maternal HIV/ART and environmental pesticides. The protocol was registered in PROSPERO. Boolean operators and tailored search strategies were used to identify relevant literature. RESULTS: Of 1,324 articles screened, 21 met the inclusion criteria. Most studies reported significant neurodevelopmental effects linked to pesticide exposure, with cognitive delays being the most frequently reported outcome. Children exposed to both pesticides and maternal HIV/ART exhibited increased risks of attention deficits and delayed milestones. Due to high heterogeneity in study design, populations, and outcome measures, meta-analysis was not feasible. South Africa showed the highest dual exposure burden, raising concerns about synergistic neurodevelopmental harm. DISCUSSION: The review highlights strong evidence linking organophosphate exposure and certain ART regimens to adverse neurodevelopmental outcomes such as ADHD and cognitive impairment in HEU children. Yet, few studies have evaluated their combined effects. CONCLUSION: Findings from Southern and Eastern Africa suggest a convergence of neurotoxic risks. Multidisciplinary, region-specific research is urgently needed to clarify the interactions between pesticide exposure and HIV/ART in early childhood neurodevelopment.

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