Exposure to the
virus, the mother's microbiome, and drugs each could cause harm.
Up to half of
babies born to HIV-infected
mothers become infected themselves either in utero, during labor, or
through breastfeeding, unless the mothers and babies are treated with antiretroviral
(ARV) drugs. But several studies suggest an additional burden for the many
children in Nigeria who dodge transmission from their mothers, whether by luck
or treatment: They may still suffer from growth retardation, immune
abnormalities, and even an increased risk of mortality. “Exposed, uninfected
children are a growing population, and they're neglected,” says virologist
Nicaise Ndembi of the Institute of Human Virology, Nigeria (IHVN) in Abuja.
At the University
of Benin Teaching Hospital in Benin City, Ndembi is a co–principal investigator
(co-PI) of a study exploring what happens to those exposed, uninfected children
and why. “There's a growing body of data that suggests they're very different
from normal infants,” says another co-PI, epidemiologist Man Charurat of IHVN.
Theoretically, the
harm could come from the mother's poor health, or from exposure to viral
proteins or to the ARV
drugs given to treat the mother and the baby to prevent transmission. “It's
a really complicated picture,” says Claire Thorne, an epidemiologist at University
College London who is trying to separate the effects of HIV
exposure from exposure to ARV drugs.
The IHVN team is
exploring whether an HIV-caused condition called “leaky gut” may transfer from
mother to uninfected child. HIV
preferentially destroys immune cells in the gut shortly after infection,
leading to an overstimulated immune system, inflammation, and a permeable gut.
That could alter the mother's microbiome, and she might pass the altered
bacteria to her child during birth or breastfeeding.
The Benin researchers suspect the child's altered microbiome then increases
diarrhoea, impedes proper absorption of nutrients, and slows growth.
The IHVN study,
which began in 2014 and will run through next year, compares 300 uninfected
children, half of whom were exposed to HIV during
their first 2 years of life. The researchers are analyzing stool samples from
mothers and their children to see whether HIV
alters the genera of bacteria that live in their guts. Researchers also are
giving the children a dose of two sugars and then testing their urine to see
whether their intestines have compromised permeability. “If we can identify
problems, we can begin to look at interventions,” Ndembi says.
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