The prevalence of adverse drug reactions to antiretroviral therapy and associated factors among pediatric patients living with HIV in sub-Saharan African countries: A systematic review and meta-analysis

INTRODUCTION: The greatest burden of HIV infection is in sub-Saharan African countries. The burden of treatment failure among children living with HIV remains significantly high due to delayed diagnosis and antiretroviral therapy (ART) initiation, low ART adherence rate, virological non-suppression, and incidence of adverse drug reactions (ADRs) to ART, among other factors. Therefore, this systematic review aims to estimate the pooled prevalence of ADRs among HIV-positive pediatric patients on ART in sub-Saharan Africa, identify the types, and examine associated risk factors as documented in the literature. METHODS: This review is based on a systematic and extensive search of PubMed, Scopus, CINAHL, Web of Science, and EBSCOHost. Data were extracted from the included studies using the data extraction form designed by the team. A meta-analysis was done using R statistics, version 4.3.2. RESULTS: A total of nine articles were included. The pooled estimate of ADRs among children on ART was statistically significant 26% (95% CI 0.15, 0.36; P-valueƒ_%<ƒ_%0.001) with high heterogeneity. The types of ADRs reported in the included studies are gastrointestinal, dermatological, central nervous system, hematological, liver pathology, metabolic disorder, cardiovascular, and hormonal imbalance symptoms. Some of the factors associated with the occurrence of ADRs include treatment duration, the combination of ART used, sex, age, malnutrition, and compliance. The pooled prevalence of mortality among children on ART was statistically significant, with high heterogeneity. CONCLUSION: The review highlighted the prevalence and factors associated with ADRs in HIV-positive children on ART in the SSA countries. As the SSA countries battle to achieve the UNAIDS 95-95-95 targets in this vulnerable population, preliminary insights from this review can help inform policies on integrating spontaneous reporting of ADRs and pharmacovigilance into the service delivery component of pediatric ART. This intervention will support patient retention in care, as ADRs are a significant cause of medication non-adherence. CLINICAL TRIAL NUMBER: Not applicable

• Epidemiology and Determinants of Health
  • Epidemiology
  • Determinants of Health
• Determinants of Health
  • Food security
• 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
• Health Systems
  • Governance arrangements