Abstract:
The widespread use of antiretroviral therapy (ART) in pregnant women has markedly reduced the incidence of pediatric HIV infections worldwide. With the recent implementation of lifelong ART for all HIV-infected women, regardless of their CD4 T cell count, an increasing number of women conceive while receiving ART. Specifically, 1.3 million women living with HIV become pregnant every year and about 80% of them receive ART. As a result, the number of children who are HIV-exposed but uninfected (CHEU) is steadily increasing to an estimated 15 million, and 90% of them live in Sub-Saharan Africa. CHEU were initially considered to be at similar risk of medical complications than children not exposed to HIV in utero. However, during the past 15 years, studies have consistently revealed that maternal HIV infection is associated with an increased risk of infectious diseases, particularly during the first months of life. CHEU present with more severe infections, are more often hospitalized for infections, have more frequent treatment failures, and in low- and middle-income countries (LMIC), have higher mortality due to infectious pathogens than infants born to mothers not infected with HIV. Severe infections are caused by a large diversity of infectious pathogens, including bacteria, viruses and parasites.