Introduction
Approximately 20% of babies in South Africa are born to mothers who are infected with HIV, and with effective mother to child prevention of transmission programs the rate of transmission to the babies during pregnancy and delivery can be as low as 5%. For reasons that remain to be explained, babies exposed to HIV but uninfected (HEU) by their mothers are at enhanced risk of poor health and development during the first year of life.
This workshop will discuss the multiple dimensions of this problem in an attempt to plan a study to explain this peculiar phenomenon. Potential contributing factors include poverty, malnutrition, lack of access to health care and exposure to adverse environmental factors and/or transmissible infectious diseases. Nonetheless, many children exposed to HIV remain healthy. It is unclear why some children fall ill and others thrive despite exposure to apparently similar environmental and social challenges. It is essential to better understand the spectrum and determinants of HIV-related health and disease in children from low and middle income countries as the first step in their prevention.
It is clear that susceptibility to disease of any type is multifaceted, involving, among other factors, genetics, environmental exposures (toxins, pollution, microbes), nutrition and psychosocial conditions. Many studies have been performed in the developed world to identify the factors that put children at risk for suffering from HIV-related illnesses, but none has identified severe disease in those babies who are not infected (HEU). There is a dearth of information from the developing world where this phenomenon has now been identified in sub-Saharan Africa and in South America. Analyses can be performed at a point in time (by case control) or in a prospective study. Whereas the latter is more expensive than the former, a cohort study has many advantages and is most likely to inform strategies for enhancing the care of children in resource-limited settings. We therefore propose to perform a longitudinal study at Tygerberg Hospital in Cape Town, South Africa to identify why HEU babies suffer so much illness during the first year of life.
"The HIV-Exposed but Uninfected Infant" workshop was a Peter Wall Institute for Advanced Studies Colloquium Abroad, held in conjunction with its partner institute, the Stellenbosch Institute for Advanced Study, South Africa.