Mechanistic Insights Into Increased Vulnerability to Respiratory Infections in HIV-Exposed Uninfected Infants

In 2024, more than 1 million children globally were born to mothers living with HIV (MLWH), more than 60% living in Sub-Saharan Africa 1 .As a result of the widespread roll-out of interventions to prevent mother-to-child transmission of HIV, the majority of these children will avoid being infected with HIV but will have been exposed to HIV-infection in utero.Moreover, recent funding cuts to HIV treatment and prevention programs, especially in Africa, are likely to exacerbate exposure of newborns to HIV.Data from around the world confirm that HIV-Exposed Uninfected (HEU) Infants experience a higher risk of severe illness and death in infancy when compared to HIV unexposed infants, despite having escaped HIV infection [2][3][4][5] .The increased risk of infection-related hospitalizations in HEU infants in the first 3 months of life persists, even in infants born to mothers who receive antiretroviral (ARV) therapy and who are breastfed. 6obally, RSV is the most common cause of lower respiratory tract infections (LRTIs) among children aged <5 years, and is responsible for approximately 33 million episodes of LRTI each year 7 .More than 95% of RSV-associated LRTI episodes occur in children from low-and