First-line ART failure in kids common

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

Drawing from the online databases of 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, yielding a total cumulative sample of 4,931 children <18 years of age treated with first-line ART.

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

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

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

According to the researchers, several factors could contribute to greater failure in girls, including delayed ART initiation due to side effects and physiological differences in metabolizing ART drugs.