Immune mechanisms underlying the increased morbidity and mortality of HIV-exposed uninfected (HEU) children

The success of anti-retroviral therapy (ART) strategies to prevent mother to child HIV transmission has revealed a new public health concern. HIV-exposed uninfected (HEU) children in sub-Saharan Africa, who account for up to 30% of all births in some parts of Africa, have been shown to experience a 2-3-fold increase in mortality compared to their unexposed counterparts. HEU infants are more likely to be stunted and have significantly increased morbidity, predominantly from infectious diseases. Whilst being born into an HIV-infected household may be associated with socio-economic disadvantages, as well as greater exposure to pathogens, increasing evidence supports a biological basis for some aspects of the ill-health of HEU children, which may reflect exposure to HIV, ART and/or co-infections. A range of immunological perturbations have been reported in HEU children, including impaired responses to some childhood vaccines.

In this edition we plan to review the clinical, epidemiological and immunological aspects of HEU children, with the aim of highlighting the health issues of this vulnerable group and suggesting future areas for research and public health policy.