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Background: Effective HIV transmission prevention strategies have led to a growing population of vulnerable HIV-and antiretroviral-exposed infants in sub-Saharan Africa, however uncertainty exists regarding their development.

Objective: To determine the developmental outcomes of HIV-exposed (HE) infants in a low-income South African con-text, when compared to HIV-unexposed (HU) counterparts.

Methods: In this prospective cross-sectional, group comparison study, the development of 41 HE and 40 HU infants (mean age= 8.4 months, SD= 2.1 months) from a low-income context was assessed. Caregivers were interviewed using the Vineland Adaptive Behavior Scales, Third Edition (Vineland-3) to evaluate infants’ development.

Results: Most HE participants had age-appropriate overall development (90.2%; n= 37). Some HE participants, however, presented with delays in domains of communication (9.8%; n= 4), daily living skills (2.4%; n= 1), socialisation (19.5%; n= 8), and motor development (7.3%; n= 3). HU participants also demonstrated some domain-specific delays, thus delays were present in both groups. No statistically significant between-group differences regarding development were found.

Conclusion: Findings were reassuring and suggested that HE and HU participants had similar development. Developmen-tal differences may, however, only emerge with age, therefore large-scale longitudinal research is recommended. It is suggest-ed that the entire sample was vulnerable, highlighting the importance of developmental surveillance in low-income contexts, irrespective of HIV and antiretroviral exposure status.