First-line antiretroviral treatment failure in children is common | Latest news for doctors, nurses and pharmacists


Failure of first-line antiretroviral therapy (ART) in children is common, especially among young girls, according to a recent meta-analysis of studies from Ethiopia.

Drawing on online databases from PubMed, Medline, Web of Science, Hinari, Google Scholar, Africa Journal Online, Open Gray Literature and other online repositories, the researchers deemed 13 studies eligible for meta- analysis, resulting in a total cumulative sample of 4,931 children under 18 treated with first-line ART.

Eleven studies were cohort and retrospective in nature, while the others were cross-sectional. In terms of quality, all studies scored at least five points on the JBI critical appraisal criteria, indicating good quality. Begg and Egger’s test found no evidence of publication bias.

The pooled analysis revealed a prevalence of first-line antiretroviral treatment failure of 14.98%. Heterogeneity of evidence was high, triggering subgroup analyses. These showed that most failures were of a virological nature (9.13%), followed by immunological (6.93%) and clinical (6.72%) failures.

First-line antiretroviral therapy failure was 40% more likely to occur in patients with a history of drug substitution (odds ratio [OR]1.39, 95% confidence interval [CI], 0.84–2.29). Similarly, girls were 42% more likely to fail ART than boys (OR, 1.42, 95% CI, 1.08-1.85).

According to the researchers, several factors could contribute to higher failure in girls, including delay in ART initiation due to side effects and physiological differences in the metabolism of antiretroviral drugs.


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