Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa.
UP Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Pretoria 0001, South Africa.
Viruses. 2023 Jan 18;15(2):279. doi: 10.3390/v15020279.
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.
随着针对感染 HIV 的女性的母婴预防计划在全球范围内的推出,许多国家的垂直传播已经基本消除。然而,越来越多的儿童在子宫内接触到 HIV 和抗逆转录病毒治疗 (ART)。这些 HIV 暴露但未感染的儿童(CHEU)现在被认为与 HIV 未暴露且未感染的儿童(CHUU)相比存在持续的健康差异。这两组之间报告的差异包括免疫功能障碍和更高水平的炎症、认知和代谢异常,以及 CHEU 中的发病率和死亡率增加。这些差异的原因在很大程度上尚不清楚。本综述重点关注免疫代谢异常与快速增长的 CHEU 人群中观察到的临床病理之间的潜在联系。通过首先引起人们对这些儿童中观察到的免疫和代谢改变的重要性的关注,其次是对其医疗保健需求的影响,特别是在中低收入国家,本综述旨在使医疗保健工作者和政策制定者认识到在子宫内接触 HIV 和 ART 的长期风险。