HIV-1 Drug Resistance in Children and Implications for Pediatric Treatment Strategies: A Systematic Review and Meta-analysis - Scorecard - MDSpire

HIV-1 Drug Resistance in Children and Implications for Pediatric Treatment Strategies: A Systematic Review and Meta-analysis

  • By

  • Joseph Fokam

  • Aude Christelle Ka’e

  • Bouba Yagai

  • Maria Mercedes Santoro

  • Judith Kose Otieno

  • Natella Rakhmanina

  • Collins Ambe Chenwi

  • Alex Durand Nka

  • Ezechiel Ngoufack Jagni Semengue

  • Davy-Hyacinthe Gouissi

  • Willy Leroi Pabo Togna

  • Nelly Kamgaing

  • Tetang Suzie

  • Desire Takou

  • Georges Teto

  • Tatiana Tekoh

  • Jeremiah Efakika Gabisa

  • Audrey Nayang Mundo

  • Lum Forgwei

  • Naomi-Karell Etame

  • Aurelie Minelle Kengni Ngueko

  • Michel Carlos Tommo Tchouaket

  • Boris Tchounga

  • Patrice Tchendjou

  • Joelle Nounouce Bouba Pamen

  • Rogers Ajeh Awoh

  • Gregory-Edie Halle-Ekane

  • Giulia Cappelli

  • Alexis Ndjolo

  • Francesca Ceccherini-Silberstein

  • Vittorio Colizzi

  • Jean Kaseya

  • Nicaise Ndembi

  • Carlo Federico Perno

  • June 26, 2025

  • 0 min

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Clinical Scorecard: Drug Resistance to HIV-1 in Pediatric Populations: Insights from a Systematic Review and Meta-Analysis on Treatment Implications

At a Glance

CategoryDetail
ConditionHIV-1 infection with drug resistance in children
Key MechanismsPretreatment drug resistance (PDR) and acquired drug resistance (ADR) driven mainly by NNRTI mutations; emerging INSTI resistance
Target PopulationChildren with HIV (CWHIV), including those exposed to PMTCT and those initiating ART
Care SettingPediatric HIV care in low- and middle-income countries (LMICs), especially sub-Saharan Africa

Key Highlights

  • High prevalence of PDR (32.48%) and ADR (61.43%) among children with HIV, predominantly due to NNRTI mutations.
  • Children failing PMTCT prophylaxis have higher PDR rates (43.23%) compared to those without PMTCT intervention.
  • Emerging integrase strand transfer inhibitor (INSTI) resistance (5.53%) underscores the need for ongoing drug resistance surveillance.

Guideline-Based Recommendations

Diagnosis

  • Implement routine HIV drug resistance genotyping as standard of care for children with HIV to guide treatment.
  • Use viral load and CD4 monitoring alongside genotypic resistance testing to assess treatment efficacy.

Management

  • Phase out pediatric NNRTI-based regimens for PMTCT and treatment due to high resistance rates.
  • Adopt dolutegravir (DTG)-based ART regimens to improve viral suppression rates in pediatric populations.
  • Ensure equitable access to efficacious and better-tolerated antiretrovirals for children.

Monitoring & Follow-up

  • Conduct continuous surveillance of HIV drug resistance patterns, including emerging INSTI resistance.
  • Monitor adherence closely, considering pediatric-specific challenges such as nondisclosure and orphanhood.

Risks

  • Recognize that suboptimal ARV exposure, poor adherence, and limited treatment options increase risk of HIV drug resistance.
  • Address programmatic challenges in LMICs such as drug stock-outs, inadequate dosing, and limited access to specialized care.

Patient & Prescribing Data

Children aged 0–14 years living with HIV, including those exposed to PMTCT and initiating ART

Despite ART rollout, only 57% of children accessed treatment in 2022; DTG-based regimens show >90% viral suppression but resistance emergence requires vigilance.

Clinical Best Practices

  • Integrate HIV drug resistance testing into routine pediatric HIV care to optimize ART regimens.
  • Prioritize use of high genetic barrier drugs like dolutegravir in pediatric ART to reduce resistance development.
  • Strengthen PMTCT programs to minimize vertical transmission and subsequent drug resistance.
  • Address adherence barriers unique to children, including psychosocial factors and disclosure issues.
  • Implement robust supply chain and healthcare infrastructure improvements in LMICs to prevent treatment interruptions.

References

Original Source(s)

HIV-1 Drug Resistance in Children and Implications for Pediatric Treatment Strategies: A Systematic Review and Meta-analysis

  • by Joseph Fokam, Aude Christelle Ka’e, Bouba Yagai, Maria Mercedes Santoro, Judith Kose Otieno, Natella Rakhmanina, Collins Ambe Chenwi, Alex Durand Nka, Ezechiel Ngoufack Jagni Semengue, Davy-Hyacinthe Gouissi, Willy Leroi Pabo Togna, Nelly Kamgaing, Tetang Suzie, Desire Takou, Georges Teto, Tatiana Tekoh, Jeremiah Efakika Gabisa, Audrey Nayang Mundo, Lum Forgwei, Naomi-Karell Etame, Aurelie Minelle Kengni Ngueko, Michel Carlos Tommo Tchouaket, Boris Tchounga, Patrice Tchendjou, Joelle Nounouce Bouba Pamen, Rogers Ajeh Awoh, Gregory-Edie Halle-Ekane, Giulia Cappelli, Alexis Ndjolo, Francesca Ceccherini-Silberstein, Vittorio Colizzi, Jean Kaseya, Nicaise Ndembi, Carlo Federico Perno

  • June 26, 2025

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