The THRIVE project aims to optimize the implementation of STOP AIDS package through research and stakeholder collaboration. A key component of the project is the Pediatric Expert Advisory Group (PEAG)...

AbstractIntroductionFailure in the prevention of mother-to-child HIV transmission (PMTCT) and pediatric treatment challenges led to pretreatment drug resistance (PDR) and acquired drug resistance (ADR) in children living with HIV (CLHIV).MethodInterventional and observational data published between 2010 and 2024 on PDR and ADR in CLHIV were included and analysed by random effects models.ResultsOverall, 72 studies encompassing 9,973 children were included. The prevalence [95%CI] of PDR was 32.48%[26.08-39.21], and high among those who failed prevention of mother-to-child transmission (PMTCT)-prophylaxis (43.23%[32.94-53.82]) vs those without PMTCT-intervention (p<0.01) and driven by non-nucleoside reverse transcriptase inhibitors (NNRTI)-mutations (28.38% [18.74-39.08]; p=0.013). The prevalence of ADR was 61.43% [49.82-72.45], driven by NNRTI-mutations (65.17% [53.95-75.63]; p<0.001). INSTI-ADR was low (5.53%[2.49-9.53]) but emerging.ConclusionThere are high burdens of PDR and ADR among CLHIV suggesting the need to phase-out pediatric-NNRTIs used for either PMTCT or treatment. Emerging INSTI-resistance among CLHIV highlights the relevance of drug-resistance surveillance strategies.Prospero registration N°CRD42023470034.