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Health and survival of HIV perinatally exposed but uninfected children born to HIV-infected mothers

Desmonde, S; Goetghebuer, T; Thorne, C; Leroy, V; (2016) Health and survival of HIV perinatally exposed but uninfected children born to HIV-infected mothers. Current Opinion in HIV and AIDS , 11 (5) pp. 465-476. 10.1097/COH.0000000000000300. Green open access

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Abstract

PURPOSE OF REVIEW: The number of HIV-exposed but uninfected (HEU) infants exposed to both HIV and multiple antiretroviral drugs in utero and during prolonged breastfeeding is increasing in low-income countries where HIV prevalence is the highest. We review recent evidence on the effects of perinatal/postnatal exposure to maternal HIV and combined antiretroviral therapy (cART) on health outcomes of HEU children (mitochondrial and metabolic toxicity, adverse pregnancy outcomes, neurodevelopment, growth, infectious morbidity, and mortality). RECENT FINDINGS: Several studies have reported ART-associated mitochondrial toxicity and metabolic disorders with conflicting results on adverse pregnancy outcomes, underscoring the need to conduct further investigations on these questions. Studies about congenital abnormalities report no significant differences between HEU exposed to ART and HIV-unexposed (HUU) children. Updated French data showed no significant difference in cancer incidence between HEU cART-exposed children and the general paediatric population. Furthermore, HEU children exposed to maternal cART have modest but significant impairment of development and a higher risk of growth impairment. Finally, HEU have higher risks of infections (mainly low respiratory tract infections and diarrhoea) and malaria than HUU children, particularly in children not breastfed or after early weaning. Higher mortality risk from infectious disease is reported in HEU compared to HUU children. SUMMARY: As we move toward the elimination of mother-to-child transmission of HIV, HEU children are an emerging population whose health outcomes remain to be fully described. Future large cohorts of HEU children using careful comparison groups of HUU in the post-ART era are needed to better understand their long-term health outcomes.

Type: Article
Title: Health and survival of HIV perinatally exposed but uninfected children born to HIV-infected mothers
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/COH.0000000000000300
Publisher version: http://doi.org/10.1097/COH.0000000000000300
Language: English
Additional information: Copyright 2016 Wolters Kluwer Health, Inc. All rights reserved. This is a non-final version of an article published in final form in Desmonde, S; Goetghebuer, T; Thorne, C; Leroy, V; (2016) Health and survival of HIV perinatally exposed but uninfected children born to HIV-infected mothers. Current Opinion in HIV and AIDS , 11 (5) pp. 465-476. 10.1097/COH.0000000000000300.
Keywords: Science & Technology, Life Sciences & Biomedicine, Immunology, Infectious Diseases, child, health, HIV-exposed uninfected, infectious morbidity, mortality, TENOFOVIR DISOPROXIL FUMARATE, IN-UTERO EXPOSURE, BREAST-FEEDING DURATION, CORD BLOOD-CELLS, ANTIRETROVIRAL THERAPY, INCREASED RISK, GROWTH OUTCOMES, BIRTH-DEFECTS, SOUTH-AFRICA, LANGUAGE OUTCOMES
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Population, Policy and Practice Dept
URI: https://discovery.ucl.ac.uk/id/eprint/1521721
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