Global data on the health of children born to women living with HIV: A systematic review
DOI:
https://doi.org/10.37800/RM.2.2026.664Keywords:
Human immunodeficiency virus (HIV), mother-to-child transmission, perinatal exposure, HIV-exposed uninfected (HEU) children, longitudinal follow-up, antiretroviral therapy (ART), public healthAbstract
Relevance: The global scale-up of prevention of mother-to-child transmission (PMTCT) programs has substantially reduced pediatric HIV infections. Consequently, the number of children born to women living with HIV who remain uninfected, referred to as HIV-exposed uninfected (HEU) children, has increased significantly. Concerns have emerged regarding their health outcomes in early life.
The study aimed to synthesize current evidence on early health outcomes among HEU children, with a focus on growth, morbidity and mortality, neurodevelopment, and maternal antibody dynamics.
Materials and Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines. A comprehensive search of PubMed, Scopus, Web of Science, ScienceDirect, the Cochrane Library, and gray literature was performed for studies published between 2015 and 2025. Eligible studies included children aged up to 60 months and reported clinical outcomes relevant to HEU populations. Methodological quality was assessed using the Newcastle-Ottawa Scale. Due to heterogeneity across studies, findings were synthesized narratively.
Results: Fourteen studies comprising 14,890 children born to women living with HIV were included, of whom 12,484 were HEU. Across the included studies, HEU children demonstrated consistently poorer growth outcomes, including lower anthropometric indices and higher risks of stunting compared with HIV-unexposed uninfected peers. Increased infectious morbidity and hospitalization rates were reported in several cohorts, while mortality reached up to 4.8% during early childhood. Maternal HIV antibody seroreversion generally occurred between 12 and 24 months of age, although delayed seroreversion was observed in a subset of children. Neurodevelopmental findings were heterogeneous, with some studies reporting mild differences in language and motor development among HEU children.
Conclusions: HEU children represent a vulnerable population with increased risks of growth impairment, infectious morbidity, altered immune development, and subtle neurodevelopmental differences. These findings highlight the need to integrate structured follow-up of HEU children into routine maternal and child health services.
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