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Clin Exp Immunol. 2014 Apr;176(1):11-22. doi: 10.1111/cei.12251.

HIV-exposed uninfected children: a growing population with a vulnerable immune system?

Author information

1
University of Bristol, Bristol, UK; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi.

Abstract

Through the successful implementation of policies to prevent mother-to-child-transmission (PMTCT) of HIV-1 infection, children born to HIV-1-infected mothers are now much less likely to acquire HIV-1 infection than previously. Nevertheless, HIV-1-exposed uninfected (HEU) children have substantially increased morbidity and mortality compared with children born to uninfected mothers (unexposed uninfected, UU), predominantly from infectious causes. Moreover, a range of phenotypical and functional immunological differences between HEU and UU children has been reported. As the number of HEU children continues to increase worldwide, two questions with clear public health importance need to be addressed: first, does exposure to HIV-1 and/or ART in utero or during infancy have direct immunological consequences, or are these poor outcomes simply attributable to the obvious disadvantages of being born into an HIV-affected household? Secondly, can we expect improved maternal care and ART regimens during and after pregnancy, together with optimized infant immunization schedules, to reduce the excess morbidity and mortality of HEU children?

KEYWORDS:

AIDS; host-pathogen interactions; vaccination

PMID:
24325737
PMCID:
PMC3958150
DOI:
10.1111/cei.12251
[Indexed for MEDLINE]
Free PMC Article
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