The study compared clinical outcomes between infants who were HIV-exposed and HIV-unexposed in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial. Despite high coverage of maternal antiretroviral therapy (ART) and uptake of exclusive breastfeeding, mortality in infants exposed to HIV was 41% higher than in infants not exposed to HIV. Infants who survived and remained HIV-free had impaired growth and development.
Analysis of blood samples from mothers and children in the trial revealed pathways contributing to higher infant mortality. Maternal systemic inflammation, measured by hiv, inflammation, infants, infant mortality, infections, crp, immune, and pregnancyC-reactive protein (CRP), was linked to increased infant mortality, suggesting interventions targeting maternal inflammation could reduce it. HIV-exposed babies, especially boys, showed altered immune development, potentially affecting their ability to fight infections.
“Collectively, these findings show how the disrupted immune system of women with HIV in pregnancy – characterized by inflammation, immune dysfunction, and co-infections – shapes immune development in their offspring. Inflammation, as indicated by CRP, is inexpensive and simple to measure, offering the immediate opportunity for point-of-care testing to be used to identify those most at risk of infant mortality, with more support provided for high-risk pregnancies” said Dr. Ceri Evans, NIHR Clinical Lecturer in Paediatric Infectious Diseases.
Moving forward, further research is warranted to elucidate the underlying mechanisms driving sex-specific differences in mortality and immune development in HIV-exposed infants. By gaining a deeper understanding of these complex interactions, researchers aim to inform targeted interventions and improve long-term health outcomes for this vulnerable population.
Reference: Evans, C., et al. (2024). Inflammation and cytomegalovirus viremia during pregnancy drive sex-differentiated differences in mortality and immune development in HIV-exposed infants. Nature Communications. doi.org/10.1038/s41467-023-44166-2.
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