{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T11:58:49Z","timestamp":1793361529826,"version":"4.5.0"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"5","funder":[{"name":"President\u2019s Emergency Plan for AIDS Relief"},{"DOI":"10.13039\/100009054","name":"PEPFAR","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100009054","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Minimal data exist on HIV drug resistance patterns and prevalence among paediatric patients failing ART in resource-limited settings. We assessed levels of HIV drug resistance in children with virological failure.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This cross-sectional study, performed from March 2017 to March 2019 in South Africa, enrolled HIV-positive children aged \u226419 years, receiving ART through public health facilities with recent evidence suggestive of virological failure (at least one viral load \u22651000 copies\/mL), across 45 randomly selected high-volume clinics from all nine provinces. Resistance genotyping was performed using next-generation sequencing technologies. Descriptive analysis taking into account survey design was used to determine outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 899 participants enrolled, the adjusted proportion of HIV drug resistance among children with virological failure was 87.5% (95% CI 83.0%\u201390.9%). Resistance to NNRTIs was detected in 77.4% (95% CI 72.5%\u201381.7%) of participants, and resistance to NRTIs in 69.5% (95% CI 62.9%\u201375.4%) of participants. Overall, resistance to PIs was detected in 7.7% (95% CI 4.4%\u201313.0%) of children.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>HIV drug resistance was highly prevalent in paediatric patients failing ART in South Africa, with 9 in 10 patients harbouring resistance to NNRTIs and\/or NRTIs. PI-based regimens are predicted to be highly efficacious in achieving virological suppression amongst patients failing NNRTI-based regimens. Scaling up resistance testing amongst patients would facilitate access to second- and third-line regimens in South Africa.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jac\/dkac443","type":"journal-article","created":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T08:49:56Z","timestamp":1680684596000},"page":"1160-1167","source":"Crossref","is-referenced-by-count":8,"title":["Resistance is common in paediatric patients failing ART in South Africa"],"prefix":"10.1093","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8933-0628","authenticated-orcid":false,"given":"Gillian M","family":"Hunt","sequence":"first","affiliation":[{"name":"Centre for HIV and STIs, National Institute for Communicable Diseases , Private Bag X4, Sandringham, Johannesburg 2131 , South Africa"},{"name":"Department of Virology, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg , South 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