Longitudinal Oral Microbiome for HIV/HEU/HUU Children aged 3-4 in Western Kenya

As of 2022, HIV-infection and HIV-related diseases are still one of the leading causes of death among children under five in spite of antiretroviral therapy (ART). HIV-exposed uninfected (HEU) children have a higher mortality rate, more frequent rates of hospitalization, and more severe manifestations of diseases. This includes an increase in their susceptibility to infectious diseases, growth retardation, and delayed neurological development. It is estimated that there are15.4 million HEU infants worldwide, 90% of whom live in sub-Saharan Africa. It is reasonable to conduct research in an area with high HIV prevalence where HEU children are relatively easy to recruit and follow-up with and then utilize these findings to inform health care policies in the United States. Cross-sectional age-stratified analysis indicates that the bacterial community composition in saliva of HEU children changes from similar to HIV children younger than three to similar to HUU children when they are four and older. This proposed study focuses on one-year change in oral microbiome during primary dentition among three cohorts in Kisumu. This research will leverage insights from an existing effort (R21TW012033) to study the dynamics of HIV progression and oral diseases. Good oral health can affect children’s growth, behavior, social interactions, and quality of life. We hypothesized that the oral microbiome of HIV-exposed uninfected (HEU) changed significantly during primary dentition (ages from >3 to <5) when compared to other two groups, those living with HIV in care (HIC) and those unexposed and uninfected (HUU). The objectives are to compare the changes in microbial abundance over time among three cohorts (HIV, HEU and HUU) and identify the association between changes in microbial abundance with HIV status change and other oral diseases over time. We proposed to use the most commonly available sequence technology 16S rRNA at V4 region, to profile the microbiome. It can be scalable in resource-limited settings in most low- and middle-income countries. We collected duplicated samples for future use to understand the detailed profile, e.g., metagenomics. This study will provide tremendous insights into oral microbiome development during the primary dentition stage among HEU children and in comparison, with their peers, HIC and HUU. Changes in the oral microbiome can help to identify the precise microbiota-targeted interventions for both mucosal inflammation and microbial diversity in oral cavity. This study will provide invaluable data to inform evidence-based priority interventions for HEU children in order to improve their health outcomes.