Abstract

Pediatric HIV infection poses unique challenges to the developing immune system, leading to profound immunodeficiency and impaired immune reconstitution despite antiretroviral therapy (ART). This review examines the mechanisms underlying immunodeficiency and immune reconstitution in pediatric HIV, focusing on the interplay between viral pathogenesis, host immune responses, and developmental factors. We discuss the clinical manifestations of immunodeficiency in pediatric HIV, including increased susceptibility to opportunistic infections and immune dysregulation. Additionally, we explore the challenges of immune reconstitution in children receiving ART, including incomplete immune recovery, persistent immune activation, and long-term complications. Finally, we review therapeutic strategies aimed at optimizing immune reconstitution and improving outcomes in pediatric HIV, including early initiation of ART, adjunctive therapies, and interventions to prevent opportunistic infections and immune dysregulation