Health Disparities Among Children Who Are HIV-Exposed but Without HIV: A Narrative Literature Review and Call to Action for Further Research

Children who are HIV-exposed but without HIV (HEU) face increased health risks compared with children without HIV exposure, including risk of higher preterm delivery, infectious morbidities, mortality, immune dysfunction, poorer growth, and neurodevelopmental delays. Underlying mechanisms are not fully understood but likely involve multiple intersecting factors, including HIV-induced parental inflammation, altered immune function, in utero antiretroviral therapy exposure, suboptimal breast/chestfeeding, and socioeconomic disparities. Although some differences appear transient, others may persist and predispose children who are HEU to a higher risk of cardiovascular, metabolic, pulmonary, and psychiatric disorders later in life. Dedicated longitudinal studies are needed to further characterize the etiologies and long-term clinical implications of these health disparities, devise tools to identify factors associated with poorer outcomes, and evaluate clinical management strategies and interventions to optimize outcomes in this growing population.