Background. The 90-90-90 goal to achieve viral suppression in 90% of all human immunodeficiency virus (HIV)–infected people on antiretroviral treatment (ART) is especially challenging in children. Global estimates of viral suppression among children in low- and middle-income countries (LMICs) are lacking. Methods. We searched for randomized controlled trials and observational studies and analyzed viral suppression rates among children started on ART during 3 time periods: early (2000–2005), intermediate (2006–2009), and current (2010 and later), using random effects meta-analysis. Results. Seventy-two studies, reporting on 51 347 children (aged <18 years), were included. After 12 months on first-line ART, viral suppression was achieved by 64.7% (95% confidence interval [CI], 57.5–71.8) in the early, 74.2% (95% CI, 70.2–78.2) in the intermediate, and 72.7% (95% 62.6–82.8) in the current time period. Rates were similar after 6 and 24 months of ART. Using an intention-to-treat analysis, 42.7% (95% CI, 33.7–51.7) in the early, 45.7% (95% CI, 33.2–58.3) in the intermediate, and 62.5% (95% CI, 53.3–72.6) in the current period were suppressed. Long-term follow-up data were scarce. Conclusions. Viral suppression rates among children on ART in LMICs were low and considerably poorer than those previously found in adults in LMICs and children in high-income countries. Little progress has been made in improving viral suppression rates over the past years. Without increased efforts to improve pediatric HIV treatment, the 90-90-90 goal for children in LMIC will not be reached.
CITATION STYLE
Boerma, R. S., Boender, T. S., Bussink, A. P., Calis, J. C. J., Bertagnolio, S., Rinke de Wit, T. F., … Sigaloff, K. C. E. (2016). Suboptimal Viral Suppression Rates among HIV-Infected Children in Low- And Middle-Income Countries: A Meta-analysis. Clinical Infectious Diseases, 63(12), 1645–1654. https://doi.org/10.1093/cid/ciw645
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