Immune and Metabolic Alterations in Children with Perinatal HIV Exposure

With the global rollout of mother-to-child prevention programs for women living with HIV, vertical transmission has been all but eliminated in many countries. However, the number of children who are exposed in utero to HIV and antiretroviral therapy (ART) is ever-increasing. These children who are HIV-exposed-but-uninfected (CHEU) are now well recognized as having persistent health disparities compared to children who are HIV-unexposed-and-uninfected (CHUU). Differences reported between these two groups include immune dysfunction and higher levels of inflammation, cognitive and metabolic abnormalities, as well as increased morbidity and mortality in CHEU. The reasons for these disparities remain largely unknown. The present review focuses on a proposed link between immunometabolic aberrations and clinical pathologies observed in the rapidly expanding CHEU population. By drawing attention, firstly, to the significance of the immune and metabolic alterations observed in these children, and secondly, the impact of their healthcare requirements, particularly in low- and middle-income countries, this review aims to sensitize healthcare workers and policymakers about the long-term risks of in utero exposure to HIV and ART.

Automated summary

With the success of mother-to-child prevention programs for women with HIV, vertical transmission has decreased significantly. However, the number of children exposed to HIV and antiretroviral therapy (ART) in utero is increasing. Children who are HIV-exposed-but-uninfected (CHEU) have persistent health disparities compared to children who are HIV-unexposed-and-uninfected (CHUU), including immune dysfunction, inflammation, cognitive and metabolic abnormalities, and higher morbidity and mortality. The reasons for these disparities are largely unknown. This review highlights the potential link between immunometabolic abnormalities and clinical pathologies in CHEU and emphasizes the importance of addressing their healthcare needs.