Second-line HIV Treatment in Ugandan Children: Favorable Outcomes and No Protease Inhibitor Resistance

J Trop Pediatr. 2017 Apr 1;63(2):135-143. doi: 10.1093/tropej/fmw062.


Background: Data on pediatric second-line antiretroviral treatment (ART) outcomes are scarce, but essential to evaluate second-line and design third-line regimens.

Methods: Children ≤12 years switching to second-line ART containing a protease inhibitor (PI) in Uganda were followed for 24 months. Viral load (VL) was determined at switch to second-line and every 6 months thereafter; genotypic resistance testing was done if VL ≥ 1000 cps/ml.

Results: 60 children were included in the analysis; all had ≥1 drug resistance mutations at switch. Twelve children (20.0%) experienced treatment failure; no PI mutations were detected. Sub-optimal adherence and underweight were associated with treatment failure.

Conclusions: No PI mutations occurred in children failing second-line ART, which is reassuring as pediatric third-line is not routinely available in these settings. Poor adherence rather than HIV drug resistance is likely to be the main mechanism for treatment failure and should receive close attention in children on second-line ART.

Keywords: HIV drug resistance; HIV-1; antiretroviral treatment; genotypic resistance testing.; second-line.

MeSH terms

  • Adolescent
  • Anti-Retroviral Agents / pharmacology
  • Anti-Retroviral Agents / therapeutic use
  • Blacks / statistics & numerical data
  • Child
  • Child, Preschool
  • Cohort Studies
  • Drug Resistance, Viral*
  • Female
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology
  • HIV Infections / virology*
  • HIV Protease Inhibitors / therapeutic use*
  • HIV-1 / drug effects*
  • HIV-1 / genetics*
  • HIV-1 / isolation & purification
  • Humans
  • Male
  • Mutation
  • Prevalence
  • Treatment Failure
  • Treatment Outcome
  • Uganda
  • Viral Load


  • Anti-Retroviral Agents
  • HIV Protease Inhibitors