Abstract
Great gains were achieved with the introduction of the United Nations' Millennium Development Goals, including improved child survival. Transition to the Sustainable Development Goals (SDGs) focused on surviving, thriving, and transforming, representing an important shift to a broader public health goal, the achievement of which holds the promise of longer-term individual and societal benefits. A similar shift is needed with respect to outcomes for infants born to women living with HIV (WLHIV). Programming to prevent vertical HIV transmission has been successful in increasingly achieving a goal of HIV-free survival for infants born to WLHIV. Unfortunately, HIV-exposed uninfected (HEU) children are not achieving comparable health and developmental outcomes compared with children born to HIV-uninfected women under similar socioeconomic circumstances. The 3rd HEU Child Workshop, held as a satellite session of the International AIDS Society's 9th IAS Conference in Paris in July 2017, provided a venue to discuss HEU child health and development disparities. A summary of the Workshop proceedings follows, providing current scientific findings, emphasizing the gap in systems for long-term monitoring, and highlighting the public health need to establish a strategic plan to better quantify the short and longer-term health and developmental outcomes of HEU children.
Highlights
Scale up of antiretroviral treatment (ART) to pregnant and breastfeeding women living with HIV (WLHIV) has had a remarkable impact on reducing infant acquisition of HIV, yielding a 47% reduction between 2010 to 2016 [1]
Maternal mortality was most strongly associated with HIV-exposed uninfected (HEU) child mortality [adjusted hazard ratio 11.1, 95% confidence interval (CI) 8.3–15.0]
HEU children of mothers on maternally-indicated ART had a 49% lower hazard of mortality compared to children of mothers receiving no antiretroviral drugs (ARVs) during pregnancy
Summary
Scale up of antiretroviral treatment (ART) to pregnant and breastfeeding women living with HIV (WLHIV) has had a remarkable impact on reducing infant acquisition of HIV, yielding a 47% reduction between 2010 to 2016 [1]. While this is a welcomed public health success, many observational studies have shown that HIV-exposed uninfected (HEU) children are not achieving equivalent health, developmental, and survival outcomes to that of situated HIV-unexposed uninfected (HUU) children born to HIV-uninfected women [2,3,4,5,6,7,8,9]. We present a summary of workshop proceedings, concluding with the need for a strategic plan to better quantify the short and longer-term health and developmental outcomes of HEU children through well-designed cohort studies as well as national and global monitoring systems
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