title: Suboptimal Viral Suppression Rates Among HIV-Infected Children in Low- and Middle-Income Countries: A Meta-analysis.
abstract: 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.
authors.affiliation: Global Child Health Group, Emma Children's Hospital.|Amsterdam Institute for Global Health and Development, Department of Global Health, Academic Medical Center of the University of Amsterdam.
authors.forename: Ragna S
authors.initials: RS
authors.lastname: Boerma
authors.affiliation: Global Child Health Group, Emma Children's Hospital.|Amsterdam Institute for Global Health and Development, Department of Global Health, Academic Medical Center of the University of Amsterdam.
authors.forename: T Sonia
authors.initials: TS
authors.lastname: Boender
authors.affiliation: Tropical Medicine Laboratory Consultancy.
authors.forename: Anton P
authors.initials: AP
authors.lastname: Bussink
authors.affiliation: Global Child Health Group, Emma Children's Hospital.|Pediatric Intensive Care Unit, Emma Children's Hospital, Academic Medical Centre, Amsterdam.
authors.forename: Job C J
authors.initials: JC
authors.lastname: Calis
authors.affiliation: HIV Department, World Health Organization, Geneva, Switzerland.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bertagnolio
authors.affiliation: Amsterdam Institute for Global Health and Development, Department of Global Health, Academic Medical Center of the University of Amsterdam.
authors.forename: Tobias F
authors.initials: TF
authors.lastname: Rinke de Wit
authors.affiliation: Global Child Health Group, Emma Children's Hospital.|Amsterdam Institute for Global Health and Development, Department of Global Health, Academic Medical Center of the University of Amsterdam.
authors.forename: Michael
authors.initials: M
authors.lastname: Boele van Hensbroek
authors.affiliation: Amsterdam Institute for Global Health and Development, Department of Global Health, Academic Medical Center of the University of Amsterdam.|Department of Internal Medicine, Division of Infectious Diseases, Leiden University Medical Centre, The Netherlands.
authors.forename: Kim C E
authors.initials: KC
authors.lastname: Sigaloff
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics / Q000821:virology*; D006801:Humans; D007182:Income; D007223:Infant; D008297:Male; D011204:Poverty Areas; D019562:Viral Load / Q000187:drug effects*
chemical_list: D019380:Anti-HIV Agents
keywords: HIV-1; LMIC; antiretroviral therapy; pediatrics; viral load