{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T16:20:57Z","timestamp":1788366057326,"version":"build-2803163510"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100017420","name":"Penta Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100017420","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"ViiV Healthcare and UK Medical Research Council","doi-asserted-by":"publisher","award":["MC_UU_00004\/03"],"award-info":[{"award-number":["MC_UU_00004\/03"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010877","name":"ViiV Healthcare and Mylan-Viatris","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010877","id-type":"DOI","asserted-by":"publisher"}]},{"name":"ODYSSEY trial"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Data on predictors of treatment failure in children starting antiretroviral therapy (ART) are limited, particularly on dolutegravir-based regimens (DTG).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>ODYSSEY demonstrated superior efficacy of DTG versus standard-of-care (SOC). We assessed predictors at ART initiation of treatment failure by 96 weeks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three hundred and eighty-one children started first-line ART (82% African). At ART-initiation, median age was 10.5 years (IQR: 6.5, 14.0, 67 &amp;lt; 3 years), CD4% 20% (IQR: 12, 28), BMI-for-age Z-score \u2013.58 (IQR:\u20131.48, +.25). One hundred and eighty-nine children started DTG, 192 started SOC (91% \u22653 years started efavirenz; 79% &amp;lt;3 years started lopinavir). Seventy-five children experienced treatment failure (24 DTG, 51 SOC). Failure risk was lower on DTG than SOC (hazard ratio [HR] = 0.47, 95% CI: 0.29\u20130.77, P = .002). Lower BMI-for-age Z-score (HR = 0.82 for each unit gain, 95% CI: 0.70\u20130.96, P = .01) and being at an African site (HR = 2.09, 95% CI: 0.82\u20135.31, P = .09) were associated with higher failure risk. Risk was also higher at younger ages with the steepest increase in the youngest children and increased at lower CD4%, with a stronger CD4% effect at younger ages. At CD4% = 20, HRs relative to age 10 years were 2.40 (95% CI: 1.58\u20133.65) at age 1 year, 1.30 (95% CI: 1.15\u20131.48) at age 5 years, and 0.80 (95% CI: 0.72\u20130.89) at age 18 years. At age 1 year, HRs relative to CD4% = 20 were 1.39 (95% CI: 1.16\u20131.66) at CD4% = 15, and 0.52 (95% CI: 0.36\u20130.75) at CD4% = 30; at age 10, corresponding estimates were 1.07 (95% CI: 0.94\u20131.20) at CD4% = 15, and 0.88 (95% CI: 0.69\u20131.13) at CD4% = 30.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Young age, low BMI-for-age, and low CD4% at ART initiation predicted higher risk of treatment failure and can guide targeted support.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciag232","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T11:48:23Z","timestamp":1775735303000},"page":"e320-e328","source":"Crossref","is-referenced-by-count":1,"title":["Predictors of Treatment Failure in Children With HIV Starting First-line Antiretroviral Therapy in the ODYSSEY 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A","family":"Mujuru","sequence":"additional","affiliation":[{"name":"University of Zimbabwe Clinical Research Centre Child Adolescent and Women's Health Department, , Harare ,","place":["Zimbabwe"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adeodata R","family":"Kekitiinwa","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine Children's Foundation Department of Research, , Kampala ,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avy","family":"Violari","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit, University of the Witwatersrand , Johannesburg ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sathaporn","family":"Na-Rajsima","sequence":"additional","affiliation":[{"name":"Pediatric Department, Mahasarakam Hospital , Maha Sarakham ,","place":["Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abbas","family":"Lugemwa","sequence":"additional","affiliation":[{"name":"Joint Clinical Research Centre (JCRC) , Mbarara Regional Centre of Excellence, Mbarara ,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ebrahim","family":"Variava","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit, University of the Witwatersrand , Johannesburg ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2559-6034","authenticated-orcid":false,"given":"Mark","family":"Cotton","sequence":"additional","affiliation":[{"name":"Family Center for Research with Ubuntu, Stellenbosch University Department of Paediatrics and Child Health, , Tygerberg ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cissy 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