Melanie A Gasper, Anna-Ursula Happel, Sonwabile Dzanibe, Jennifer Slyker, Heather B Jaspan
{"title":"Immunology of infants who are HIV-exposed uninfected in the parental combination antiretroviral therapy era.","authors":"Melanie A Gasper, Anna-Ursula Happel, Sonwabile Dzanibe, Jennifer Slyker, Heather B Jaspan","doi":"10.1016/S2352-3018(25)00184-5","DOIUrl":null,"url":null,"abstract":"<p><p>The introduction and programmatic scale-up of universal antiretroviral therapy in pregnancy (option B and option B+) and the subsequent universal test-and-treat approaches have dramatically reduced infant HIV-1 acquisitions globally, with a parallel increase in the number of infants who are HIV-exposed uninfected (HEU). Although infants who are HEU have historically had higher risk of morbidity and mortality than infants who are HIV unexposed, effective parental viral suppression has enabled people living with HIV to carry healthier pregnancies and realise the benefits of optimised feeding practices that support the transfer of key nutrients and immune factors through their parent's own milk. However, residual, heightened inflammation, altered gut microbiome, and differences in innate and adaptive immunology in infants who are HEU remain, and might contribute to persistent, heightened infectious morbidity. Parental HIV infection continues to influence child health in the option B and option B+ era; future research is needed to uncover underlying mechanisms and long-term implications of these strategies.</p>","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":""},"PeriodicalIF":13.0000,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lancet Hiv","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/S2352-3018(25)00184-5","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
The introduction and programmatic scale-up of universal antiretroviral therapy in pregnancy (option B and option B+) and the subsequent universal test-and-treat approaches have dramatically reduced infant HIV-1 acquisitions globally, with a parallel increase in the number of infants who are HIV-exposed uninfected (HEU). Although infants who are HEU have historically had higher risk of morbidity and mortality than infants who are HIV unexposed, effective parental viral suppression has enabled people living with HIV to carry healthier pregnancies and realise the benefits of optimised feeding practices that support the transfer of key nutrients and immune factors through their parent's own milk. However, residual, heightened inflammation, altered gut microbiome, and differences in innate and adaptive immunology in infants who are HEU remain, and might contribute to persistent, heightened infectious morbidity. Parental HIV infection continues to influence child health in the option B and option B+ era; future research is needed to uncover underlying mechanisms and long-term implications of these strategies.
期刊介绍:
The Lancet HIV is an internationally trusted source of clinical, public health, and global health knowledge with an Impact Factor of 16.1. It is dedicated to publishing original research, evidence-based reviews, and insightful features that advocate for change in or illuminates HIV clinical practice. The journal aims to provide a holistic view of the pandemic, covering clinical, epidemiological, and operational disciplines. It publishes content on innovative treatments and the biological research behind them, novel methods of service delivery, and new approaches to confronting HIV/AIDS worldwide. The Lancet HIV publishes various types of content including articles, reviews, comments, correspondences, and viewpoints. It also publishes series that aim to shape and drive positive change in clinical practice and health policy in areas of need in HIV. The journal is indexed by several abstracting and indexing services, including Crossref, Embase, Essential Science Indicators, MEDLINE, PubMed, SCIE and Scopus.