Pediatric Antiretroviral Therapy Outcomes in Resource-Limited Settings

Over the past decade, paediatric antiretroviral therapy (ART) in low- and middle-income regions has transformed HIV from a fatal illness into a chronic, manageable condition for many children. Despite this progress, resource constraints—ranging from delayed diagnosis and stock-outs of child-friendly formulations to shortages of trained personnel—continue to undermine optimal treatment outcomes. Early initiation of ART has been linked to improved immune recovery, reduced mortality and better growth trajectories, yet in practice many children start therapy at advanced disease stages. High rates of early mortality, particularly within the first six months, and significant loss to follow-up persist as major challenges. Nutritional deficits, anaemia and opportunistic infections exacerbate vulnerability, while caregiver factors and geographical barriers affect adherence and retention in care. Recent advances in fixed-dose paediatric combinations and simplified monitoring algorithms offer promise, but robust data on long-term viral suppression, neurodevelopmental outcomes and programme durability remain limited. A comprehensive understanding of predictors for attrition, mortality and treatment failure is essential to refine guidelines and support tailored interventions in diverse, under-resourced settings.

Research from Nature Portfolio

A recent large retrospective cohort analysis evaluated attrition among 359 children on ART over an eight-year period in a high-burden Ethiopian region. The study reported an attrition incidence of 9.8 per 100 person-years, driven by poor adherence, baseline anaemia (haemoglobin <10 g/dl), opportunistic infections and early drug toxicities. Children experiencing adverse effects or low haemoglobin were nearly four times more likely to discontinue therapy or be lost from care. These findings underscore the need for early screening of haematological status, enhanced adherence support and vigilant management of side effects to reduce early programme attrition and improve paediatric outcomes.

Pediatric Antiretroviral Therapy Outcomes in Resource-Limited Settings publication trend

The graph below shows the total number of articles in pediatric antiretroviral therapy outcomes in resource-limited settings across all publications each year (not limited to Nature Index journals).

Technical terms

Attrition: Combined measure of death and loss to follow-up among patients on therapy.

CD4 count: A laboratory measure of immune cell levels indicating degree of immunosuppression.

Adherence: The extent to which a patient follows prescribed medication schedules.

Viral suppression: Reduction of HIV RNA in blood to undetectable levels under ART.

Opportunistic infection: Illness caused by pathogens taking advantage of weakened immunity.

References

1. Incidence and predictors of attrition among human immunodeficiency virus infected children on antiretroviral therapy in Amhara comprehensive specialized hospitals, Northwest Ethiopia, 2022: a retrospective cohort study. Scientific Reports (2024).
2. Mortality among pediatric patients on HIV treatment in sub-Saharan African countries: a systematic review and meta-analysis. BMC Public Health (2019).
3. Rates and predictors of attrition among children on antiretroviral therapy in Ethiopia: A prospective cohort study. PLOS ONE (2018).
4. Trends in Antiretroviral Therapy Eligibility and Coverage Among Children Aged. MMWR Morbidity and Mortality Weekly Report (2018).