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 living with HIV (CLHIV). Method Interventional and observational data published between 2010 and 2024 on PDR and ADR in CLHIV were included and analysed by random effects models. Results Overall, 72 studies encompassing 9,973 children were included. The prevalence [95%CI] of PDR was 32.48%[26.08-39.21], and high among those who failed prevention of mother-to-child transmission (PMTCT)-prophylaxis (43.23%[32.94-53.82]) vs those without PMTCT-intervention (p<0.01) and driven by non-nucleoside reverse transcriptase inhibitors (NNRTI)-mutations (28.38% [18.74-39.08]; p=0.013). The prevalence of ADR was 61.43% [49.82-72.45], driven by NNRTI-mutations (65.17% [53.95-75.63]; p<0.001). INSTI-ADR was low (5.53%[2.49-9.53]) but emerging. Conclusion There are high burdens of PDR and ADR among CLHIV suggesting the need to phase-out pediatric-NNRTIs used for either PMTCT or treatment. Emerging INSTI-resistance among CLHIV highlights the relevance of drug-resistance surveillance strategies.
HIV-1 drug resistance in children and implications for pediatric treatment strategies: A systematic review and meta-analysis
Yagai, Bouba;
2025-01-01
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 living with HIV (CLHIV). Method Interventional and observational data published between 2010 and 2024 on PDR and ADR in CLHIV were included and analysed by random effects models. Results Overall, 72 studies encompassing 9,973 children were included. The prevalence [95%CI] of PDR was 32.48%[26.08-39.21], and high among those who failed prevention of mother-to-child transmission (PMTCT)-prophylaxis (43.23%[32.94-53.82]) vs those without PMTCT-intervention (p<0.01) and driven by non-nucleoside reverse transcriptase inhibitors (NNRTI)-mutations (28.38% [18.74-39.08]; p=0.013). The prevalence of ADR was 61.43% [49.82-72.45], driven by NNRTI-mutations (65.17% [53.95-75.63]; p<0.001). INSTI-ADR was low (5.53%[2.49-9.53]) but emerging. Conclusion There are high burdens of PDR and ADR among CLHIV suggesting the need to phase-out pediatric-NNRTIs used for either PMTCT or treatment. Emerging INSTI-resistance among CLHIV highlights the relevance of drug-resistance surveillance strategies.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
