HIV-1 Drug Resistance in Children and Implications for Pediatric Treatment Strategies: A Systematic Review and Meta-analysis
Abstract
INTRODUCTION: Failure in the prevention of mother-to-child HIV transmission (PMTCT) and pediatric treatment challenges led to pretreatment drug resistance (PDR) and acquired drug resistance (ADR) in children with HIV (CWHIV). METHOD: Interventional and observational data published between 2010 and 2024 on PDR and ADR in CWHIV were included and analyzed by random effects models. RESULTS: Overall, 72 studies encompassing 9973 children were included. The prevalence (95% CI) of PDR was 32.48% (26.08-39.21), and high among those who failed PMTCT prophylaxis (43.23% [32.94-53.82]) versus those without PMTCT-intervention (P < .01) and driven by nonnucleoside reverse transcriptase inhibitors (NNRTI) mutations (28.38% [18.74-39.08]; P = .013). The prevalence of ADR was 61.43% (49.82-72.45), driven by NNRTI-mutations (65.17% [53.95-75.63]; P < .001). INSTI-ADR was low (5.53% [2.49-9.53]) but emerging. CONCLUSION: There are high burdens of PDR and ADR among CWHIV, suggesting the need to phase out pediatric NNRTIs used for either PMTCT or treatment. Emerging INSTI resistance among CWHIV highlights the relevance of drug-resistance surveillance strategies. PROSPERO REGISTRATION NO: CRD42023470034
Authors
Fokam J, Ka'e AC, Yagai B, Santoro MM, Otieno JK, Rakhmanina N, Chenwi CA, Nka AD, Ngoufack Jagni Semengue E, Gouissi DH, Togna WLP, Kamgaing N, Suzie T, Takou D, Teto G, Tekoh T, Gabisa JE, Nayang Mundo A, Forgwei L, Etame NK, Kengni Ngueko AM, Tommo Tchouaket MC, Tchounga B, Tchendjou P, Bouba Pamen JN, Ajeh Awoh R, Halle-Ekane GE, Cappelli G, Ndjolo A, Ceccherini-Silberstein F, Colizzi V, Kaseya J, Ndembi N, Perno CF
Year
2025
Topics
- Population(s)
- Children or Youth (less than 18 years old)
- General HIV+ population
- Prevention, Engagement and Care Cascade
- Engagement and Care Cascade
- Engagement and Care Cascade
- Treatment
