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Suboptimal viral suppression rates among HIV-infected children in low- and middle-income countries: a meta-analysis.

Suboptimal viral suppression rates among HIV-infected children in low- and middle-income countries: a meta-analysis.
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Boerma RS, Boender TS, Bussink AP, Calis JC, Bertagnolio S, Rinke de Wit TF, Boele van Hensbroek M, Sigaloff KC,


Boerma RS, Boender TS, Bussink AP, Calis JC, Bertagnolio S, Rinke de Wit TF, Boele van Hensbroek M, Sigaloff KC, (click to view)

Boerma RS, Boender TS, Bussink AP, Calis JC, Bertagnolio S, Rinke de Wit TF, Boele van Hensbroek M, Sigaloff KC,

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Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2016 9 22() pii

Abstract
BACKGROUND
 The 90-90-90 goals aim to achieve viral suppression in 90% of all HIV-infected people on antiretroviral treatment (ART), which is especially challenging in children. Global estimates of viral suppression among children in low- and middle-income countries (LMIC) are lacking. This study summarizes viral suppression rates in children on first-line ART in LMIC since the year 2000.

METHODS
 We searched for randomized controlled trials and observational studies and analyzed viral suppression rates among children started on ART during three time periods, based on major World Health Organization (WHO) guideline changes: 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 and adolescents (<18 years), were included. After 12 months on first-line ART, viral suppression was achieved by 64.7% (95%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. CONCLUSION
 Viral suppression rates among children on ART in LMIC were low and were considerably poorer than those previously found in adults in LMIC 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 targets for children in LMIC will not be reached.

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