Optimizing Research Methods to Understand HIV-Exposed Uninfected Infant and Child Morbidity: Report of the Second HEU Infant and Child Workshop

Résumé

The first HIV Exposed Uninfected (HEU) Infant and Child Workshop was held in Vancouver in July 2015, hosted by the Child and Family Research Institute at the British Columbia Children's Hospital and University of British Columbia.This event brought together 50 clinicians, epidemiologists, and basic scientists to review current knowledge of HEU infants, their clinical course, immunologic differences, and risk for neurodevelopmental and infectious morbidity.This Frontiers in Immunology Research Topic, "Immune mechanisms underlying the increased morbidity and mortality of HIVexposed uninfected (HEU) children, " is a product of the first HEU workshop synthesizing the evidence in the field.It was clear from the first workshop that there is a committed community of researchers who have identified the need to understand the mechanisms of increased morbidity and mortality in HEU infants and children, but evidence to intervene and mitigate these risks is lacking.In high HIV burden countries, all infants and children, irrespective of HIV exposure, are vulnerable to high rates of infant and child mortality (1).In this context, the essential question is whether HEU children are any different than HIV-unexposed uninfected (HUU) children experiencing similar nutritional, environmental, and social constraints to health.To this end, particular research methodological principles require reinforcing in future HEU research.It was these methodological challenges and possible solutions that formed the theme of the second HEU Infant and Child Workshop attended by 75 HEU researchers and hosted by the KwaZulu-Natal Research Institute for Tuberculosis and HIV at the University of KwaZulu-Natal in Durban, South Africa.We report on the specific methodological challenges tackled during the workshop and steps to move forward. ACCURATE CLASSiFiCATiOn OF HiV-EXpOSED CHiLDREnAccurately excluding HIV infection and classifying infants as HEU is essential to ensuring integrity of HEU morbidity research to be certain that morbidity assigned to HEU infants is not in fact due to undiagnosed HIV-infection.Moreover, misclassification of HEU infants as HIVinfected or delayed diagnosis of HIV infection have detrimental life-long implications.The infant HIV diagnostic dilemmas emerging in the setting of expanding maternal antiretroviral therapy (ART), prolonged infant postnatal prophylaxis, and decreasing vertical HIV transmission were

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