Understanding HIV-Exposed Uninfected Children: A Narrative Review

The widespread implementation of antiretroviral therapy has significantly reduced HIV-related mortality and mother-to-child transmission. Despite being HIV-uninfected, HIV-exposed children (HEU) seem to face heightened risks of immune dysfunction, cardiometabolic diseases, growth delays, reduction i...

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Main Authors: Martina Salvi, Benedetta Fioretti, Maria Alberti, Irene Scarvaglieri, Stefania Arsuffi, Giorgio Tiecco, Francesco Castelli, Eugenia Quiros-Roldan
Format: Article
Language:English
Published: MDPI AG 2025-03-01
Series:Viruses
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Online Access:https://www.mdpi.com/1999-4915/17/3/442
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author Martina Salvi
Benedetta Fioretti
Maria Alberti
Irene Scarvaglieri
Stefania Arsuffi
Giorgio Tiecco
Francesco Castelli
Eugenia Quiros-Roldan
author_facet Martina Salvi
Benedetta Fioretti
Maria Alberti
Irene Scarvaglieri
Stefania Arsuffi
Giorgio Tiecco
Francesco Castelli
Eugenia Quiros-Roldan
author_sort Martina Salvi
collection DOAJ
description The widespread implementation of antiretroviral therapy has significantly reduced HIV-related mortality and mother-to-child transmission. Despite being HIV-uninfected, HIV-exposed children (HEU) seem to face heightened risks of immune dysfunction, cardiometabolic diseases, growth delays, reduction in bone mineral density, and neurocognitive impairments compared to HIV-unexposed uninfected peers. These vulnerabilities can be attributed to maternal immune dysregulation during pregnancy, antiretroviral (ART) toxicity, HIV exposure, and adverse socioeconomic and nutritional environments. Emerging evidence highlights the impact of antiviral therapy exposure, particularly tenofovir disoproxil fumarate, on HEU mitochondrial dysfunction, bone resorption, neurocognitive delays, and zidovudine on cardiac abnormalities. This narrative review explores the multisystem effects of ART exposure in HEU children, focusing on immune function, neurodevelopment, cardiovascular health, growth, and bone metabolism. By synthesizing findings from diverse studies, the review aims to provide a comprehensive understanding of the potential risks associated with ART regimens and identify future research priorities to improve outcomes for HEU children.
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series Viruses
spelling doaj-art-d73686cb16454804a86d1eb14d0e52172025-08-20T01:50:10ZengMDPI AGViruses1999-49152025-03-0117344210.3390/v17030442Understanding HIV-Exposed Uninfected Children: A Narrative ReviewMartina Salvi0Benedetta Fioretti1Maria Alberti2Irene Scarvaglieri3Stefania Arsuffi4Giorgio Tiecco5Francesco Castelli6Eugenia Quiros-Roldan7Department of Clinical and Experimental Sciences, SD of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, ItalyDepartment of Clinical and Experimental Sciences, SD of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, ItalyDepartment of Clinical and Experimental Sciences, SD of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, ItalyDepartment of Clinical and Experimental Sciences, SD of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, ItalyDepartment of Clinical and Experimental Sciences, SD of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, ItalyDepartment of Clinical and Experimental Sciences, SD of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, ItalyDepartment of Clinical and Experimental Sciences, SD of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, ItalyDepartment of Clinical and Experimental Sciences, SD of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, ItalyThe widespread implementation of antiretroviral therapy has significantly reduced HIV-related mortality and mother-to-child transmission. Despite being HIV-uninfected, HIV-exposed children (HEU) seem to face heightened risks of immune dysfunction, cardiometabolic diseases, growth delays, reduction in bone mineral density, and neurocognitive impairments compared to HIV-unexposed uninfected peers. These vulnerabilities can be attributed to maternal immune dysregulation during pregnancy, antiretroviral (ART) toxicity, HIV exposure, and adverse socioeconomic and nutritional environments. Emerging evidence highlights the impact of antiviral therapy exposure, particularly tenofovir disoproxil fumarate, on HEU mitochondrial dysfunction, bone resorption, neurocognitive delays, and zidovudine on cardiac abnormalities. This narrative review explores the multisystem effects of ART exposure in HEU children, focusing on immune function, neurodevelopment, cardiovascular health, growth, and bone metabolism. By synthesizing findings from diverse studies, the review aims to provide a comprehensive understanding of the potential risks associated with ART regimens and identify future research priorities to improve outcomes for HEU children.https://www.mdpi.com/1999-4915/17/3/442HIV-exposed uninfected childrenHEUHIV maternal exposurecardiovascularbonegrowth
spellingShingle Martina Salvi
Benedetta Fioretti
Maria Alberti
Irene Scarvaglieri
Stefania Arsuffi
Giorgio Tiecco
Francesco Castelli
Eugenia Quiros-Roldan
Understanding HIV-Exposed Uninfected Children: A Narrative Review
Viruses
HIV-exposed uninfected children
HEU
HIV maternal exposure
cardiovascular
bone
growth
title Understanding HIV-Exposed Uninfected Children: A Narrative Review
title_full Understanding HIV-Exposed Uninfected Children: A Narrative Review
title_fullStr Understanding HIV-Exposed Uninfected Children: A Narrative Review
title_full_unstemmed Understanding HIV-Exposed Uninfected Children: A Narrative Review
title_short Understanding HIV-Exposed Uninfected Children: A Narrative Review
title_sort understanding hiv exposed uninfected children a narrative review
topic HIV-exposed uninfected children
HEU
HIV maternal exposure
cardiovascular
bone
growth
url https://www.mdpi.com/1999-4915/17/3/442
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