Abstract
The developing brain is especially vulnerable to infection and suboptimal nutrition during the pre- and early postnatal periods. Exposure to maternal human immunodeficiency virus (HIV) infection and antiretroviral therapies (ART) in utero and during breastfeeding can adversely influence infant (neuro) developmental trajectories. How early life nutrition may be optimised to improve neurodevelopmental outcomes for infants who are HIV-exposed has not been well characterised. We conducted an up-to-date evidence review and meta-analysis on the influence of HIV exposure in utero and during breastfeeding, and early life nutrition, on infant neurodevelopmental outcomes before age three. We report that exposure to maternal HIV infection may adversely influence expressive language development, in particular, and these effects may be detectable within the first three years of life. Further, while male infants may be especially vulnerable to HIV exposure, few studies overall reported sex-comparisons, and whether there are sex-dependent effects of HIV exposure on neurodevelopment remains a critical knowledge gap to fill. Lastly, early life nutrition interventions, including daily maternal multivitamin supplementation during the perinatal period, may improve neurodevelopmental outcomes for infants who are HIV-exposed. Our findings suggest that the early nutritional environment may be leveraged to improve early neurodevelopmental trajectories in infants who have been exposed to HIV in utero. A clear understanding of how this environment should be optimised is key for developing targeted nutrition interventions during critical developmental periods in order to mitigate adverse outcomes later in life and should be a priority of future research.
Highlights
Maternal human immunodeficiency virus (HIV) infection has profound effects on maternal physiology, fetoplacental development, and pregnancy outcomes
We examined sex differences in neurodevelopment and how early life nutrition factors may influence these outcomes for infants who were exposed to HIV, given that male infants are often more susceptible to developmental insults experienced in utero in comparison to female infants [17]
We found that infants who were HIV-exposed and perinatally infected (HEI) had poorer neurodevelopmental outcomes in multiple domains in comparison to infants who were HEU
Summary
Maternal human immunodeficiency virus (HIV) infection has profound effects on maternal physiology, fetoplacental development, and pregnancy outcomes. The number of children born annually who are HIV-exposed (in utero and during breastfeeding) but are uninfected (HEU) themselves is rising [2]. It is estimated that there are currently 15.2 million children globally who are HEU [2]. The extent to which exposure to maternal HIV infection may have lasting impacts on the development of children who are HEU and the influence of other decisive exposures, including early life nutrition, on these outcomes remains to be thoroughly explored. This gap in understanding limits the development and use of Nutrients 2020, 12, 3375; doi:10.3390/nu12113375 www.mdpi.com/journal/nutrients
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