Growth and Neurodevelopment of HIV-Exposed Uninfected Children: a Conceptual Framework
Growth and Neurodevelopment of HIV-Exposed Uninfected Children: a Conceptual Framework
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DOI：
10.1007/s11904-019-00459-0
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发表时间：
2019-12-01
影响因子：
4.6
通讯作者：
Prendergast, Andrew J.
中科院分区：
文献类型：
--
作者：
Wedderburn, Catherine J.;Evans, Ceri;Prendergast, Andrew J.
受艾滋病毒感染但未受感染的儿童人数正在迅速增加，全球每年有100多万高浓缩铀婴儿出生。最近的几项研究报告说，使用高浓缩铀的儿童，特别是低收入和中等收入国家的儿童，有可能出现不良后果，包括生长和神经发育受损。然而，高浓缩铀儿童临床结果不佳的原因仍不清楚。最近的发现我们总结了最近的大型研究的结果，这些研究描述了HEU儿童的生长和神经发育，确定了风险因素并探索了潜在的机制途径。我们提出了一个概念框架来解释如何暴露于艾滋病毒和抗逆转录病毒治疗（ART）可能会导致不良生长和神经发育未感染的儿童，并审查现有的证据和研究差距。我们认为，HEU儿童受到间接影响，通过增加普遍的风险因素，潜在的不良生长和神经发育，并直接通过艾滋病毒/抗逆转录病毒治疗的具体途径，最终可能会通过一系列共同的致病机制。在普遍的ART时代，更好地了解这些途径对于告知未来的预防和干预策略至关重要。
Purpose of Review The population of HIV-exposed uninfected (HEU) children is expanding rapidly, and over one million HEU infants are born each year globally. Several recent studies have reported that HEU children, particularly in low- and middle-income countries, are at risk of poor outcomes, including impaired growth and neurodevelopment. However, the reasons for poor clinical outcomes amongst HEU children remain unclear. Recent Findings We summarise the findings from recent large studies that have characterised growth and neurodevelopment in HEU children, identified risk factors and explored underlying mechanistic pathways. We propose a conceptual framework to explain how exposure to HIV and antiretroviral therapy (ART) may lead to adverse growth and neurodevelopment in uninfected children, and review the available evidence and research gaps. We propose that HEU children are affected both indirectly, through the augmentation of universal risk factors underlying poor growth and neurodevelopment, and directly through HIV/ART-specific pathways, which ultimately may converge through a series of common pathogenic mechanisms. In the era of universal ART, a better understanding of these pathways is crucial to inform future prevention and intervention strategies.