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

## TL;DR

Children exposed to HIV but not infected face higher health risks, including immune issues and developmental delays, likely due to multiple factors like inflammation and socioeconomic disparities.

## Contribution

This paper reviews health disparities in HIV-exposed but uninfected children and calls for longitudinal studies to better understand and address these risks.

## Key findings

- HEU children have higher risks of preterm delivery, infections, and immune dysfunction.
- Exposure to antiretroviral therapy and socioeconomic factors may contribute to long-term health issues.
- Persistent health disparities may increase the risk of chronic diseases later in life.

## Abstract

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.