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Diagnosis and Treatment of Viral Infections in Children: HIV and...
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Diagnosis and Treatment of Viral Infections in Children: HIV and Cytomegalovirus

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Infectious Diseases".

Deadline for manuscript submissions: closed (20 January 2026) | Viewed by 5736

Special Issue Editor

Dr. Selina Pasquero

E-Mail Website
Guest Editor
Department of Public Health and Pediatric Sciences, Medical School, University of Turin, 10124 Turin, Italy
Interests: microbiology; virology; herpesviruses; coronaviruses; oncovirus; antiviral therapy; antiviral molecules; host-targete antivirals; post-translational modifications; citrullination; deimination; peptidyl-arginine deiminases enzymes; senescence; antiviral restriction factors; innate immunity; cellular senescence.

Special Issue Information

Dear Colleagues,

Viral infections, particularly HIV and cytomegalovirus (CMV), represent significant challenges in pediatric healthcare, contributing to substantial morbidity and mortality worldwide. Children are particularly vulnerable to these infections due to immature immune systems, limited access to early diagnostic tools, and the complexity of therapeutic regimens. While advances in antiretroviral therapies and antiviral drugs have improved outcomes, there remain gaps in the early diagnosis, personalized treatment strategies, and long-term management of these infections.

This Special Issue aims to explore innovative approaches and emerging trends in the management of pediatric HIV and CMV infections. The objective is to bring together contributions that advance our understanding of these infections, from epidemiology and pathogenesis to cutting-edge diagnostic tools and novel therapeutic interventions.

In this Special Issue, we welcome original research articles, review articles, case studies, and short communications. Research areas may include, but are not limited to, the following topics:

  • Advances in molecular diagnostics and biomarkers for HIV and CMV in children;
  • Innovations in antiretroviral and antiviral therapies for children;
  • Mechanisms of vertical transmission and strategies for prevention;
  • Immune response and immunomodulatory therapies in pediatric populations;
  • Challenges in managing co-infections and comorbidities;
  • Public health strategies to reduce the burden of HIV and CMV in resource-limited settings;
  • Long-term outcomes and quality of life in children living with HIV or CMV.
Dr. Selina Pasquero
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pediatric viral infections
  • HIV
  • cytomegalovirus
  • diagnostics
  • antiretroviral therapy
  • immunology
  • vertical transmission
  • molecular biomarkers
  • antiviral treatment

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Published Papers (4 papers)

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Review

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20 pages, 695 KB  
Review
The Long Shadow of Early HCMV–HIV Coinfection: Epidemiology, Pathogenesis, and Immune Consequences
by Camilla Albano, Francesca Gugliesi, Greta Bajetto, Beatrice Braga, Valentina Dell’Oste, Gloria Griffante and Selina Pasquero
Children 2026, 13(2), 236; https://doi.org/10.3390/children13020236 - 7 Feb 2026
Viewed by 555
Abstract
Human cytomegalovirus (HCMV) and Human Immunodeficiency Virus (HIV) are two pathogens known to have dramatic consequences when contracted early in life. In addition to having a significant impact when acquired individually, these two viruses are known to frequently cause coinfections. Indeed, also in [...] Read more.
Human cytomegalovirus (HCMV) and Human Immunodeficiency Virus (HIV) are two pathogens known to have dramatic consequences when contracted early in life. In addition to having a significant impact when acquired individually, these two viruses are known to frequently cause coinfections. Indeed, also in the modern era, HCMV remains one of the most prevalent coinfections in newborns of mothers living with HIV, including both HIV-positive children regardless of their immune status, and those exposed to HIV but uninfected (HEU). In children with HIV infection, HCMV coinfection has historically been associated with AIDS-defining disease, high mortality, and prolonged, elevated HCMV viral load. Although timely administration of antiretroviral therapy prevents immunodeficiency in people living with HIV and thus reduces the incidence of full-blown HCMV disease in cases of coinfection, emerging data suggest that HCMV-induced immune activation and aging persist, potentially contributing to long-term, non-AIDS-related comorbidities. Growing evidence indicates that also HCMV amplifies HIV susceptibility, disease progression, and immune dysregulation through multiple synergistic mechanisms. Moreover, congenital and early postnatal HCMV infections occur at significantly higher rates in HEU newborns than in HIV-unexposed children and are associated with worse clinical outcomes, particularly when HCMV viral loads are high. This review summarizes current knowledge on the epidemiology, clinical impact, and immunopathogenetic interactions of early HCMV–HIV coinfection in pediatric populations. By integrating recent findings with historical evidence, it highlights critical mechanistic and epidemiological gaps that warrant further investigation. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Viral Infections in Children: HIV and Cytomegalovirus)
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27 pages, 2694 KB  
Review
Postnatally Acquired Neonatal CMV Infection in Preterm Infants: From a Case Series to a Narrative Review of the Literature
by Serena Salomè, Ida D’Acunzo, Clara Coppola, Giovanna Montesano, Gaetano Ausanio, Angela Umbaldo, Fiorella Migliaro, Letizia Capasso and Francesco Raimondi
Children 2026, 13(1), 46; https://doi.org/10.3390/children13010046 - 29 Dec 2025
Viewed by 1193
Abstract
Background: Postnatal cytomegalovirus (pCMV) infection is a frequent viral condition in early infancy and is primarily acquired through maternal breastfeeding. Although usually asymptomatic in term infants, it can lead to significant morbidity in preterm neonates (gestational age < 32 weeks) and in those [...] Read more.
Background: Postnatal cytomegalovirus (pCMV) infection is a frequent viral condition in early infancy and is primarily acquired through maternal breastfeeding. Although usually asymptomatic in term infants, it can lead to significant morbidity in preterm neonates (gestational age < 32 weeks) and in those with very low birthweight (<1500 g), presenting with sepsis-like syndrome, pneumonia, cytopenia, hepatitis, or colitis. Severe cases may result in long-term sequelae or death. Objectives: To describe a series of cases of pCMV infection and review the current evidence on its epidemiology, clinical manifestations, outcomes, and therapeutic management, aiming to identify gaps in knowledge and propose opportunities for improving the care of preterm infants. Methods: We analyzed clinical presentations of pCMV disease in a case series of preterm infants and reported cases and reviewed the recent literature regarding diagnostic approaches, antiviral therapy, and strategies for breastmilk management. Results: Current data highlight substantial variability in clinical management and outcomes. The lack of consensus on antiviral indications and treatment duration reflects a limited understanding of the disease’s natural history. Approaches to breastmilk handling differ widely among centers and countries, further complicating the standardization of care. Conclusions: pCMV infection remains a relevant yet under-recognized condition in neonatal medicine. Improved diagnostic strategies, clearer therapeutic guidelines, and harmonized recommendations for breastmilk management are needed to optimize the care of preterm infants at risk of or affected by pCMV disease. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Viral Infections in Children: HIV and Cytomegalovirus)
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11 pages, 579 KB  
Review
Proposed Mechanistic Axis of Infections and mTOR Hyperactivation: A Multidisciplinary Review of Immune, Rheumatologic, and Psychiatric Links
by Giovanni Fronticelli Baldelli and Danilo Buonsenso
Children 2025, 12(12), 1603; https://doi.org/10.3390/children12121603 - 25 Nov 2025
Viewed by 1167
Abstract
Early-life infections can produce durable changes in immune function and behavior. We propose a mechanistic hypothesis positioning the mechanistic target of rapamycin (mTOR) as the link between peripheral inflammation and central nervous system dysfunction in pediatric post-infectious syndromes. Based on clinical, translational, and [...] Read more.
Early-life infections can produce durable changes in immune function and behavior. We propose a mechanistic hypothesis positioning the mechanistic target of rapamycin (mTOR) as the link between peripheral inflammation and central nervous system dysfunction in pediatric post-infectious syndromes. Based on clinical, translational, and experimental literature, we outline a stepwise pathway. First, sustained mTOR activation skews T-cell and macrophage differentiation toward pro-inflammatory and autoimmune states. Second, endothelial mTOR signaling weakens tight junctions and increases vesicular transport, compromising blood–brain barrier integrity. Third, cytokines and sometimes autoreactive cells enter the brain and engage mTOR in microglia and neurons, driving neuroinflammation, impaired synaptic maintenance and plasticity, and neurotransmitter disruption. This framework accounts for features observed in Long COVID, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and pediatric acute neuropsychiatry syndrome (PANS/PANDAS) and yields testable predictions on pathway activity and barrier permeability. It also motivates targeted interventions that modulate mTOR-related processes in immune and endothelial compartments and within neural circuits in children. So, this article aims to outline a mechanistic framework linking infection-driven mTOR activation to post-infectious neuropsychiatric syndromes. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Viral Infections in Children: HIV and Cytomegalovirus)
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15 pages, 239 KB  
Case Report
Clinical Presentation of Postnatally Acquired Cytomegalovirus Infection in Preterm Infants—A Case Series Report
by Dobrochna Wojciechowska, Dominika Galli, Justyna Kowalczewska, Tomasz Szczapa and Katarzyna Ewa Wróblewska-Seniuk
Children 2025, 12(7), 900; https://doi.org/10.3390/children12070900 - 8 Jul 2025
Cited by 2 | Viewed by 2266
Abstract
Background: Human cytomegalovirus (HCMV) is the leading cause of congenital and acquired viral infections in newborns. While acquired infections are often asymptomatic, premature infants—especially those born before 30 weeks of gestation or with a very low birth weight (<1500 g)—are at an [...] Read more.
Background: Human cytomegalovirus (HCMV) is the leading cause of congenital and acquired viral infections in newborns. While acquired infections are often asymptomatic, premature infants—especially those born before 30 weeks of gestation or with a very low birth weight (<1500 g)—are at an increased risk for severe infections. These can manifest as thrombocytopenia, liver failure, sepsis-like symptoms, and, in rare cases, death. HCMV is transmitted through various human secretions, including breast milk, which is the optimal feeding method for premature infants. Methods: We present five premature neonates, born between 23 and 26 weeks of gestation, each with a distinct clinical presentation of acquired HCMV infection. Results: All infants tested negative for congenital CMV infection via molecular urine testing within the first three weeks of life. Acquired infection was diagnosed between the second and third month of life, with symptoms such as septic shock, persistent thrombocytopenia, and signs of liver failure. Each infant received antiviral treatment along with regular viral load monitoring. Unfortunately, one patient died due to complications of prematurity. The remaining infants were discharged and continue to receive follow-up care in an outpatient clinic. Conclusions: These cases of postnatally acquired CMV infection aim to increase awareness of its highly heterogeneous and nonspecific clinical presentation, which may result in an incorrect, delayed, or concealed diagnosis. Currently, there are no clear guidelines on how to manage the presence of the virus in maternal breast milk, particularly for premature infants. It should be recommended to perform a molecular CMV test in all breast-fed preterm infants who present with sepsis-like symptoms, thrombocytopenia, liver failure, or other organ involvement. In case of a confirmed aCMV diagnosis, appropriate treatment should be introduced. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Viral Infections in Children: HIV and Cytomegalovirus)
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