Becoming HIV-Exposed, Uninfected Children Born to HIV-Positive Mothers Followed at Bichat Claude Bernard Hospital
Becoming HIV-Exposed, Uninfected Children Born to HIV-Positive Mothers Followed at Bichat Claude Bernard Hospital
"The strategies for the Prevention of Mother-to-Child Transmission of the Human Immunodeficiency Virus (HIV) are very effective and have become common practices in many contexts.
Some studies have identified clinical and biological anomalies in a small proportion of infants exposed to antiretrovirals. Beyond 2 years of age, there are few studies with low power describing the long-term consequences of perinatal exposure to antiretrovirals.
It is necessary to understand the impact of antiretroviral treatment during the perinatal period in order to improve the management of children born to HIV-positive mothers.
Retrospective cohort study with interviews of women living with HIV who were followed for a pregnancy in the Infectious diseases department of Bichat-Claude Bernard Hospital, PARIS, France.
After recruitment during a follow-up consultation:
The latest WHO report shows that with 1.3 million (between 970,000 and 1.6 million) HIV-positive pregnant women worldwide in 2020, HIV remains a major global public health issue.
In France, about 2 per 1,000 pregnant women are infected with HIV, resulting in approximately 1,500 births per year over the past fifteen years. The administration of antiretroviral treatment to HIV-positive pregnant women and prophylaxis for infants immediately after birth is the most effective means of preventing mother-to-child transmission (MTCT) of HIV. This risk has been estimated at 0.2% during the period from 2011 to 2017 among women included in the French perinatal survey.
While the number of children infected with HIV is decreasing due to wider access to antiretroviral treatments during pregnancy, the number of HIV-exposed but uninfected children is increasing, raising questions about their long-term outcomes.
Some historical studies have identified clinical and biological anomalies, including lactic acidosis, cardiomyopathy, and neurological anomalies, suggesting mitochondrial dysfunction in a small proportion of uninfected children exposed to antiretrovirals.
Since then, recent studies have provided new evidence suggesting that HIV-exposed but uninfected children, while avoiding vertical transmission of HIV, are at a higher risk of suboptimal health outcomes, including higher rates of severe infectious morbidity, lower early childhood survival, and more frequent occurrences of growth delay and neurological development issues compared to children born without HIV exposure.
Additionally, concerns have been raised about neural tube closure anomalies in children exposed to efavirenz and dolutegravir at the time of conception. However, recent data showed that the prevalence of neural tube closure anomalies did not differ significantly between dolutegravir and other antiretrovirals since conception.
Nonetheless, some studies have acknowledged methodological weaknesses, indicating that further research is needed to evaluate each medication individually and how antiretroviral treatment regimens affect the outcomes of infants during the perinatal period.
Consensus guidelines recommend follow-up for HIV-exposed but uninfected children up to 24 months of age. Currently, there is no active long-term follow-up program in France for asymptomatic children. Follow-up may be extended if the child presents a clinical or biological anomaly. Families should be informed of the importance of reporting significant clinical events to their healthcare provider and/or the center that monitored the child in the early months of life. The healthcare provider managing the mother may also play a role in the long-term screening of significant clinical events in the child by gathering information from the mother he or she follows.
Beyond 2 years of age, there are few studies with low power describing the long-term consequences of in utero or perinatal exposure to antiretrovirals.
The participation of children and their parents in observational studies is essential for research, necessary to monitor and identify long-term health outcomes following perinatal exposure to HIV and antiretrovirals.
The objective of this retrospective study is to describe the outcomes of HIV-exposed but uninfected children born to HIV-positive mothers followed at Bichat-Claude Bernard Hospital
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Exclusion Criteria