Early neurodevelopment of HIV-exposed uninfected children in the era of antiretroviral therapy: a systematic review and meta-analysis

Wedderburn, Catherine J; Weldon, Ella; Bertran-Cobo, Cesc; Rehman, Andrea M.; Stein, Dan J.; Gibb, Diana; Yeung, Shunmay; Prendergast, Andrew J.; Donald, Kirsten A.

doi:10.1016/s2352-4642(22)00071-2

Cited by 39 publications

(50 citation statements)

References 76 publications

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“…Multiple studies have now reported neurodevelopmental outcomes in children who are HEU compared with children who are HIV-unexposed. A recent meta-analysis [38] identified eight high-quality studies of almost 5000 children, and showed that children who are HEU have modest impairments in gross motor and expressive language development in early life. Even small differences in individual child development attainment may have a major impact on human capital in countries with a large population of children who are HIV-exposed and uninfected [14].…”

Section: Growth and Development In Children Who Are Hiv-exposed But U...mentioning

confidence: 99%

Children who are HIV-exposed and uninfected: evidence for action

Prendergast

Evans

2023

Aids

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Prior to widespread availability of antiretroviral therapy (ART) in sub-Saharan Africa, children who were HIV-exposed but uninfected (HEU) had increased mortality, morbidity and undernutrition compared with children who were HIV-unexposed. Scale-up of ART has led to impressive declines in vertical HIV transmission, but over 15 million children are now HEU, 90% of whom live in sub-Saharan Africa. There are ongoing health disparities among children who are HEU, with higher mortality, morbidity and stunting and modest impairments in early child development, which collectively hamper health and human capital in high prevalence countries. The underlying causes are multifactorial and include exposure to HIV, co-infections and a skewed antenatal inflammatory milieu, particularly if mothers start ART once they have advanced disease, as well as socioeconomic risk factors, which may cluster in HIV-affected households. Improving maternal health through early and sustained ART, ensuring optimal breastfeeding, and implementing evidence-based priority interventions for all children in areas of high HIV prevalence, will likely improve outcomes. A more comprehensive intervention package based on the Nurturing Care Framework may have particular benefits for children who are HEU, to close health gaps and ensure that the next generation of HIV-free children survive and thrive, and lead healthy and productive lives.

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Section: Growth and Development In Children Who Are Hiv-exposed But U...mentioning

confidence: 99%

Children who are HIV-exposed and uninfected: evidence for action

Prendergast

Evans

2023

Aids

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“…An estimated 15.4 million children globally are now living within the context of early-life exposure to HIV and/or ART [ 4 ]. This is 600,000 more children than the 2018 estimate of 14.8 million, with the great majority (13.2 million) of CHEU living in sub-Saharan Africa [ 11 ].…”

Section: The Global Picture Of Cheu: Prevalence Morbidity and Mortalitymentioning

confidence: 99%

“…Only once ART had been established as the standard of care, coinciding with significant improvement in morbidity and mortality outcomes of children living with HIV, did CHEU become apparent as a risk group in their own right, with proven and persistent health disparities when compared to children who are HIV-unexposed-and-uninfected (CHUU) [ 3 ]. This has major implications for healthcare systems, especially for regions with a high maternal HIV prevalence, such as southern Africa where >20% of children are born to mothers living with HIV [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Immune and Metabolic Alterations in Children with Perinatal HIV Exposure

Toit

Prinsloo

Steel

et al. 2023

Viruses

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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.

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“…While large studies have been done in the global North, less is known about the risk architecture of intellectual and developmental disabilities in African ecosystems. Prospective studies, conducted in the last decade, have shown that nutrition (including iron-deficiency anaemia), infections (e.g., HIV and malaria), environmental stimulation and interaction, and psychosocial factors may all impact brain development ( Wedderburn et al, 2022 ). In addition, social/gender inequalities further amplify developmental differences.…”

Section: Six Domains Of Distinction For Potential Of Neuroscience In ...mentioning

confidence: 99%

What is next in African neuroscience?

Donald

Maina

Patel

et al. 2022

eLife

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Working in Africa provides neuroscientists with opportunities that are not available in other continents. Populations in this region exhibit the greatest genetic diversity; they live in ecosystems with diverse flora and fauna; and they face unique stresses to brain health, including child brain health and development, due to high levels of traumatic brain injury and diseases endemic to the region. However, the neuroscience community in Africa has yet to reach its full potential. In this article we report the outcomes from a series of meetings at which the African neuroscience community came together to identify barriers and opportunities, and to discuss ways forward. This exercise resulted in the identification of six domains of distinction in African neuroscience: the diverse DNA of African populations; diverse flora, fauna and ecosystems for comparative research; child brain health and development; the impact of climate change on mental and neurological health; access to clinical populations with important conditions less prevalent in the global North; and resourcefulness in the reuse and adaption of existing technologies and resources to answer new questions. The article also outlines plans to advance the field of neuroscience in Africa in order to unlock the potential of African neuroscientists to address regional and global mental health and neurological problems.

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Early neurodevelopment of HIV-exposed uninfected children in the era of antiretroviral therapy: a systematic review and meta-analysis

Cited by 39 publications

References 76 publications

Children who are HIV-exposed and uninfected: evidence for action

Children who are HIV-exposed and uninfected: evidence for action

Immune and Metabolic Alterations in Children with Perinatal HIV Exposure

What is next in African neuroscience?

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