Program seeks Council approval for an initiative titled “Optimizing the Health of Children and Adolescents with Perinatal HIV Exposure.” The number of children exposed to HIV and antiretroviral therapy (ART) in utero and during breastfeeding who are uninfected (HEU) will continue to increase from the estimated 15.9 million children in 2021. Furthermore, an increasing number of these children are now growing into adolescence (13–18 years of age) and young adulthood (18–21 yearsof age). A number of studies indicate that children who are HEU are at increased risk for preterm delivery, mortality, infectious morbidity, immune abnormalities, and impaired growth. Delays in cognitive, motor, language and neurodevelopment have been reported in early childhood. In addition, there is a disproportionate impact of other exposures, psychosocial and structural factors, and social determinants of health inequalities on the children and youth growing up in an environment affected by HIV.
The goal of this initiative is to understand the milieu of factors contributing to the health outcomes of populations who are HEU, including social determinants, inequitable access to services, stigma, structural inequalities, exposures toother infectious diseases or environmental factors, and exposures to new ART regimens. Innovative approaches to understand the long-term impact over the life course will allow for better identification of those in need of and development of early opportunities for prevention and treatment.
This proposed concept aligns with the NICHD Strategic Plan Themes 3: Setting the Foundation for Healthy Pregnancies and Lifelong Wellness, Strategic Plan Theme 4: Improving Child and Adolescent Health and the Transition to Adulthood, and Strategic Plan Cross-Cutting Topics: Disease Prevention, Global Health, Health Disparities, Infectious Disease.
This proposed concept aligns with the Office of AIDS Research and MPIDB research priorities of a) reducing the incidence of HIV/AIDS infections b) HIV-associated comorbidities, coinfections, and complications and c)Cross-Cutting Areas.
[Previously, we funded 5 awards that have supported epidemiology research of large cohorts of children who are HEU in Botswana, Kenya, Malawi, South Africa, and Zimbabwe, and substantially expanded our understanding of health in these populations include growth and nutrition, hearing, mental health, cognition, academic achievement, and cardiovascular fitness. However, much remains to be done to improve our understanding of the development of immune system early in life and how it contributes to susceptibility to infections in adolescence and young adulthood, maternal co-infections with HIV specifically CMV which alters immune responses to make both the pregnant person and infant more susceptible to other infections, and reproductive health outcomes in populations who are HEU.]
Maternal and Pediatric Infectious Disease Branch (MPIDB)
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