Abstract
Despite the significant progress that has been made to eliminate vertical HIV infection, more than 150,000 children were infected with HIV in 2019, emphasizing the continued need for sustainable HIV treatment strategies and ideally a cure for children. Mother-to-child-transmission (MTCT) remains the most important route of pediatric HIV acquisition and, in absence of prevention measures, transmission rates range from 15% to 45% via three distinct routes: in utero, intrapartum, and in the postnatal period through breastfeeding. The exact mechanisms and biological basis of these different routes of transmission are not yet fully understood. Some infants escape infection despite significant virus exposure, while others do not, suggesting possible maternal or fetal immune protective factors including the presence of HIV-specific antibodies. Here we summarize the unique aspects of HIV MTCT including the immunopathogenesis of the different routes of transmission, and how transmission in the antenatal or postnatal periods may affect early life immune responses and HIV persistence. A more refined understanding of the complex interaction between viral, maternal, and fetal/infant factors may enhance the pursuit of strategies to achieve an HIV cure for pediatric populations.
Highlights
Pediatric AIDS was first described in 1982, shortly after the first adult cases were reported [1]
We aim to summarize what is known about HIV MTCT, the immunologic and virologic factors involved in HIV transmission in the fetal and neonatal/infant periods, and provide implications for HIV cure strategies targeting perinatally infected children
Mother-to-child transmission (MTCT) remains the most important route of pediatric HIV acquisition and, in the absence of preventative measures, transmission rates range from 15% to 45% via three distinct routes: in utero, intrapartum, and in the postnatal period through breastfeeding
Summary
Pediatric AIDS was first described in 1982, shortly after the first adult cases were reported [1]. While heterosexual transmission is the major transmission mode in adults, the majority of pediatric infections occur through mother-to-child transmission (MTCT) during pregnancy, labor and delivery, and postpartum through breastfeeding. Despite the implementation of prevention of mother-to-child transmission (PMTCT) measures that decrease the risk of vertical HIV transmission to less than 5% [3, 4], approximately 150,000 children were newly infected with HIV in 2020, the majority of whom live in sub-Saharan Africa [5]. Risk of MTCT transmission is influenced by geography, maternal viral load, co-infections, delivery mode, and breast-feeding [6], among other factors. We aim to summarize what is known about HIV MTCT, the immunologic and virologic factors involved in HIV transmission in the fetal and neonatal/infant periods, and provide implications for HIV cure strategies targeting perinatally infected children
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