Prevention, suppression, and resistance Antiretroviral treatment for children with HIV in sub-Saharan Africa

This thesis describes the virological and clinical outcomes of children with HIV in sub-Saharan Africa who start antiretroviral treatment (ART). We show that pretreatment HIV drug resistance among children is a serious problem in sub-Saharan Africa and that its prevalence is increasing. Children who start first-line ART have much lower virological suppression rates compared to adults and data on long-term treatment outcomes of these children are largely missing. Outcomes of children on second-line ART, containing a protease inhibitor, are relatively favorable for young children, but the rate of virological failure among adolescents is alarmingly high. Although major improvements have been made in HIV treatment in sub-Saharan Africa over the past 15 years, these advances have not been realized on the same scale in children. We conclude that, in order to improve pediatric HIV care in sub-Saharan Africa, a combination of better drugs, improved drug access, and child-friendly HIV treatment is urgently needed.