A LARGE-scale French study has found that children exposed to human immunodeficiency virus (HIV) and antiretroviral (ARV) treatments during pregnancy face a higher risk of developing neurodevelopmental disorders. The findings, based on data from over six million births between 2012 and 2022, have highlighted the need for long-term monitoring of these children.
The research, conducted using the French National Health Data System, followed 9,035 children born to mothers living with HIV, all of whom were exposed to ARVs in utero. These children were compared to a matched cohort from the general population based on sociodemographic factors and gestational age. Over an average follow-up period of 5.5 years (up to 11 years in some cases), the study found that neurodevelopmental disorders were more common in the HIV-exposed group, with a hazard ratio of 1.24 (95% confidence interval, 1.04–1.47).
While the study could not distinguish whether maternal HIV infection or ARV treatment played a greater role in this increased risk, it identified a specific concern related to the use of certain ARV regimens. Among children exposed to the commonly used tenofovir-emtricitabine combination, those whose mothers were treated with ritonavir-boosted darunavir had a significantly higher incidence of neurodevelopmental disorders and required more specialised medical consultations compared to those exposed to other protease inhibitors.
The findings underscore the complex nature of neurodevelopmental risks in this population, which may stem from multiple factors, including HIV exposure, maternal health, and ARV medication. Experts stress the importance of ongoing research to better understand these risks and to refine treatment strategies for pregnant women living with HIV.
“This study adds to the growing body of evidence that children exposed to HIV and antiretrovirals in the womb may require closer developmental monitoring,” the researchers stated. They called for further studies to clarify the long-term impact and potential interventions to mitigate risks.
As global efforts continue to prevent mother-to-child transmission of HIV, researchers and healthcare professionals must balance effective maternal treatment with minimising potential risks to child development.
Reference
Collier M et al. Risk of neurodevelopmental disorders in children exposed to human immunodeficiency virus and antiretrovirals in utero: a national cohort study in France. Clin Infect Dis. 2025;DOI:10.1093/cid/ciae610.
