SynthesisThe lancet. HIV2025
HIV-related mortality time trends among children and young adolescents on antiretroviral therapy by age, treatment duration, and region: a systematic review and meta-regression analysis.
Synthesis in The lancet. HIV, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 3 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
3 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Risk and Protective Factors Associated With HIV-Related Mortality in Children Receiving Antiretroviral Therapy: A Model-Based Meta-Regression.JAMA pediatrics · 2026Pooled it
- Death after discharge among children living with HIV admitted with suspected sepsis in Uganda: A secondary analysis of two prospective observational studies.HIV medicine · 2026Observational
- Maternal Engagement in HIV Care and Antiretroviral Therapy Uptake Among Children Living With HIV.JAMA network open · 2026Article
Corrections and comments
- Erratum issued
Authors and funding
26 authors.
Funding
Abstract
backgroundPast cohort studies have examined mortality among children and young adolescents (aged 0-14 years) who have received antiretroviral therapy (ART), but no systematic reviews have been undertaken to synthesise these findings. Our study aims to provide the most comprehensive global estimates of paediatric mortality among children and adolescents receiving ART.
methodsFor this systematic review and meta-regression analysis, we searched PubMed and Embase from Jan 1, 1990 to July 31, 2024 for studies reporting mortality among children and young adolescents living with HIV who were on ART. We employed the meta-regression with Bayesian priors, regularisation, and trimming tool, developed for the Global Burden of Disease study 2019, for meta-regression analysis to estimate on-ART mortality by region, CD4 cell count or percentage, age, sex, and treatment duration. We assessed the robustness of our results by doing a sensitivity analysis, restricting it to studies of good quality using the quality assessment tool adapted from the Newcastle-Ottawa Scale and the National Heart, Lung, and Blood Institute. This study has been registered with PROSPERO (CRD42022382702).
findingsOur literature search identified 7588 records, of which 5853 were determined relevant for title and abstract review. Following screening, 1068 records were selected for full-text assessment. We included 84 studies in our systematic review, of which 66 were included in the meta-regression analysis. Our analysis indicated that HIV-related mortality for all children and young adolescents (aged 0-14 years) decreased over time, between 2000 and 2020 globally, after adjusting for region, baseline CD4 cell count, age, treatment duration, and sex. Additionally, HIV-related mortality decreased with increasing CD4 cell count at ART initiation and longer treatment duration. There have been considerable geographical variations in the risk of mortality. Among the high-mortality group in 2020 (ART duration <6 months, age <1 year, male, and the lowest CD4 cell counts), HIV-related mortality across regions ranged from 11·7 deaths (95% CI 8·3-15·4) per 100 person-years in eastern Sub-Saharan Africa to 72·0 deaths (47·1-98·1) per 100 person-years in Asia-Pacific. Among the low-mortality group in 2020 (ART duration ≥1 year, age 5-9 years, female, and the highest CD4 cell counts), HIV-related mortality ranged from 0·09 deaths (0·07-0·10) per 100 person-years in eastern Sub-Saharan Africa to 0·20 deaths (0·03-0·80) per 100 person-years in Latin America and the Caribbean.
interpretationA comprehensive approach to paediatric HIV care is essential to improving outcomes for children and young adolescents living with HIV. Clinically, this approach includes strengthening the prevention of vertical transmission, ensuring early diagnosis in infants, and initiating treatment promptly-ideally at higher CD4 cell counts. From a policy perspective, health systems need to address disparities in treatment access and outcomes across regions, age groups, and sex. Efforts should also prioritise minimising treatment dropout and expanding access to high-quality HIV services. These strategies could collectively support global goals to reduce the burden of paediatric HIV.
fundingThe National Institute of Allergy and Infectious Diseases and the National Institutes of Health.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.