Estimates of the global population of children who are HIV-exposed and uninfected, 2000–18: a modelling study

Abstract

Background Children who are HIV-exposed uninfected (HEU) have higher morbidity and mortality than children who are HIV-unexposed and uninfected despite safer breastfeeding and improved maternal health with maternal antiretroviral therapy. We present the first global estimates of the population of children who are HEU (aged 0-14 years) and the geographical and temporal trends in HIV high-burden countries between 2000 and 2018. Methods The Spectrum AIDS Impact Module developed by Avenir Health, UNAIDS, and partners is used to estimate key HIV epidemic indicators from mathematical models. We used 2019 UNAIDS global estimates of children (aged 0-14 years) who are HEU generated by Spectrum and 2017 UN Population Division estimates of the number of all children in each region or country to estimate the regional or national prevalence of children who were HEU, the regional or national contribution of children who were HEU to the global population of children who were HEU, and the proportion of children who were HEU and exposed to antiretrovirals for six UNAIDS regions and 21 HIV highburden countries in 2018. We also estimated the percentage change in the global population of children who were HEU between 2000 and 2018. Findings In 2018, there were an estimated 14•8 million (lower estimate 11•1-upper estimate 18•3) children who were HEU, 13•2 million (9•8-16•3; 90%) of whom resided in sub-Saharan Africa and 760 000 (640 000-970 000; 5%) of whom resided in the Asia and Pacific region. Five countries accounted for 50% of all 14•8 million children who were HEU globally: South Africa (3•5 million [23•8%]), Uganda (1•1 million [7•5%]), Mozambique (1•0 million [6•6%]), Tanzania (910 000 [6•1%]); and Nigeria (880 000 [6•0%]). In five southern African countries, the prevalence of children who were HEU exceeded 15% of the general child population: eSwatini (32•4%), Botswana (27•4%), South Africa (21•6%), Lesotho (21•1%), and Namibia (16•4%). Interpretation The global population of children who are HEU is substantial, requiring a coordinated strategy to reduce HIV exposure in children and ensure optimal health and wellbeing of children who are HEU and their families. Future research and programmatic funding investments must be aligned with the geographical distribution of children who are HEU.

Vitamin D status, nutrition and growth in HIV-infected mothers and HIV-exposed infants and children in Botswana

“…Poor vitamin D status is common in patients with human immunodeficiency virus (HIV) in the United States [ 1 ], but there is not substantial evidence on prevalence of vitamin D deficiency in HIV infected and exposed populations in low- and middle-income countries [ 2 ], such as Botswana [ 3 ]. Botswana has the third highest prevalence of HIV in the world and over 15% of children are HIV-exposed [ 4 , 5 ]. Determining the prevalence of vitamin D insufficiency in this population is of great importance.…”

Advances in Neonatal Infections

“…20 HIV While 1.3 million women with HIV become pregnant each year, there has been a significant decline in the number of neonatal infections globally. 21 Prevention of maternal-fetal transmission is achieved with prenatal screening, intrapartum medications, as well as prophylaxis, in the neonate after birth. Advances in antiretroviral therapies have transformed this lifelong infection into a chronic medical condition, but there are several associated significant comorbidities.…”

Integration of Early Infant Diagnosis of HIV Services Into Village Health Clinics in Ntcheu, Malawi: An Exploratory Qualitative Study

“… 1 , 2 Early Infant Diagnosis of HIV is a step within the PMTCT services and falls within the third and fourth prongs. 3 The third and fourth prongs focus on preventing transmission of HIV from infected mothers to their children and provision of care, treatment, and support for HIV-infected mothers, their children, and families respectively. 3 The WHO pediatric treatment guidelines recommend that all HIV infected children less than 2 years of age initiate on Antiretroviral Therapy (ART) to promote their survival.…”

“… 3 The third and fourth prongs focus on preventing transmission of HIV from infected mothers to their children and provision of care, treatment, and support for HIV-infected mothers, their children, and families respectively. 3 The WHO pediatric treatment guidelines recommend that all HIV infected children less than 2 years of age initiate on Antiretroviral Therapy (ART) to promote their survival. 1 - 3 To facilitate immediate ART initiation following HIV diagnosis, WHO recommends HIV testing among all HIV-exposed infants at 6 weeks, ideally before 2 months, and further tests at 12 and 24 months of age.…”