Growing Up with HIV: A Comprehensive Review of Treatment and Care in Low- and Middle-Income Countries.

PURPOSE OF REVIEW: Despite declining numbers of new pediatric HIV infections and advancements in treatment for children and adolescents living with HIV (CALHIV), barriers remain. Comprehensive care for CALHIV in low- and middle-income countries is challenged by limited treatment options, unique psychosocial challenges, and caregiver reliance. Successful care relies on understanding the unique developmental needs, as well as their vulnerabilities to treatment failure and HIV drug resistance.

RECENT FINDINGS: CALHIV lag behind adults in meeting global UNAIDS targets. Increasing availability of pediatric fixed dose combinations (FDC) of abacavir/lamivudine/dolutegravir (ABC/3TC/DTG) may address some challenges but providing alternatives should be prioritized. Emerging evidence has demonstrated pre-treatment and acquired HIV drug resistance (HIVDR) are more prevalent in CALHIV. While novel therapies are in development, access remains a concern. Increased child and adolescent-friendly treatment options are needed to provide quality life-long comprehensive care to CALHIV in low- and middle-income countries (LMIC). Expanded research and access to novel therapies is key to close treatment gaps between CALHIV and their adult counterparts and address emerging HIV drug resistance.