A systematic review and meta-analysis published in Pediatric Research has examined how exposure to HIV during pregnancy, childbirth, or breastfeeding may be related to neurodevelopmental disorders in children. The study, led by researchers including C.E.F. Dantas, G.A.d.S.L. Lins, and A.G.A. Soares, focuses on a population that has expanded substantially since the introduction of effective antiretroviral therapy: children who are exposed to HIV but do not themselves acquire the virus.
Mother-to-child HIV transmission occurs when the virus passes from an infected mother to her infant during pregnancy, delivery, or breastfeeding. Without intervention, HIV can cross biological barriers or reach the infant through infected blood and breast milk. Antiretroviral treatment, viral-load monitoring, planned delivery when appropriate, and carefully managed infant feeding have reduced transmission dramatically. As a result, increasing numbers of children are growing up HIV-free despite having experienced exposure to the virus and, in many cases, to antiretroviral medicines before birth.
The new review addresses an important scientific distinction between HIV infection and HIV exposure. Children living with HIV may experience direct effects of viral replication, inflammation, immune activation, and treatment. HIV-exposed but uninfected children do not carry the virus, yet their development may still be influenced by the biological and social conditions surrounding maternal infection. These can include prenatal inflammation, maternal illness, nutritional problems, socioeconomic stress, premature birth, and exposure to medications during critical stages of fetal brain development.
Neurodevelopmental disorders are not a single condition. They include difficulties affecting cognition, language, motor coordination, attention, learning, behavior, communication, and social interaction. Brain development begins before birth and continues through childhood, relying on tightly regulated processes such as neuronal migration, synapse formation, myelination, and the maturation of neural circuits. Disruptions to these processes may not become apparent immediately, which is why long-term developmental follow-up is important even when an infant appears healthy at birth.
In a systematic review, investigators search the scientific literature using predefined criteria, assess the quality of eligible studies, and compare results across different populations and research settings. A meta-analysis then combines quantitative findings when the studies are sufficiently comparable. This approach can increase statistical power, but it cannot eliminate differences in how researchers define HIV exposure, measure development, select comparison groups, or account for factors such as prematurity and maternal health.
The authors’ work brings together evidence on the relationship between perinatal HIV exposure and neurodevelopmental outcomes. The central issue is whether children exposed to HIV show higher rates of developmental difficulties than children who were neither exposed to HIV nor antiretroviral therapy. Any association identified in such research must be interpreted carefully: it may reflect a biological effect of maternal infection, treatment exposure, complications of pregnancy, or broader environmental circumstances rather than a single causal pathway.
Several mechanisms could plausibly connect maternal HIV infection with later developmental differences. Even when antiretroviral therapy suppresses the virus, chronic immune activation and inflammatory signaling may persist. Inflammation can influence the placenta, alter fetal immune development, and affect the chemical environment in which the brain forms. Maternal HIV may also be associated with anemia, co-infections, depression, inadequate nutrition, and reduced access to prenatal care. Each of these factors can independently influence early brain development, making it difficult to isolate the contribution of HIV exposure itself.
Antiretroviral drugs add another layer of scientific complexity. These medicines are essential for protecting the mother’s health and preventing transmission, and their benefits are overwhelmingly established. At the same time, researchers continue to study how different drug combinations might interact with fetal or infant development. Exposure does not necessarily mean harm, and an observed association cannot automatically be attributed to medication. The timing of exposure, drug concentration, genetic susceptibility, placental transport, and the health consequences of untreated maternal HIV all need to be considered together.
The findings have practical implications for pediatric care and public health. They do not weaken the case for preventing mother-to-child transmission; rather, they support a broader model of care in which HIV-exposed infants receive both infection surveillance and developmental monitoring. Early screening for language, motor, cognitive, behavioral, and social difficulties can allow families to access speech therapy, educational support, developmental pediatrics, and other interventions before problems become entrenched. Future studies will need larger cohorts, standardized developmental assessments, longer follow-up, and comparison groups that account for maternal health, treatment history, birth complications, and social conditions.
The review also highlights how the success of HIV prevention has changed the scientific questions facing medicine. The priority is no longer only whether a child becomes infected, but also how prenatal exposure to maternal infection, treatment, inflammation, and environmental adversity may shape health across the life course. Understanding these relationships can help clinicians balance the extraordinary benefits of antiretroviral therapy with more precise developmental surveillance. For families affected by HIV, the goal is a complete picture of child health—one that includes freedom from infection as well as the opportunity for healthy neurological and developmental growth.
Subject of Research: The relationship between mother-to-child HIV exposure and neurodevelopmental disorders in children.
Article Title: Mother-to-child HIV exposure and its relation with neurodevelopmental disorders: a systematic review and meta-analysis.
Article References: Dantas, C.E.F., Lins, G.A.d.S.L., Soares, A.G.A. et al. Mother-to-child HIV exposure and its relation with neurodevelopmental disorders: a systematic review and meta-analysis. Pediatric Research (2026). https://doi.org/10.1038/s41390-026-05252-5
Image Credits: AI Generated
DOI: 10.1038/s41390-026-05252-5
Keywords: HIV, mother-to-child transmission, HIV-exposed uninfected children, neurodevelopment, developmental disorders, antiretroviral therapy, prenatal exposure, pediatric health, systematic review, meta-analysis
