HIV-1 Drug Resistance Mutations in Children: A Systematic Review of Global Genotypic Evidence (2014-2026).

HIV-1 infection in children remains a major public health challenge, particularly in resource-limited settings where access to antiretroviral therapy (ART) and routine virological monitoring is limited. The emergence of HIV-1 drug resistance mutations (DRMs) compromises treatment efficacy and threatens long-term therapeutic outcomes. A systematic literature review was conducted using PubMed and Scopus to identify studies published from 2014 onward reporting HIV-1 genotypic resistance profiles in children receiving ART. Eligible studies included original research using Sanger sequencing or next-generation sequencing (NGS). Due to substantial methodological heterogeneity in study design, sequencing approaches, patient populations, and outcome reporting, a meta-analysis was not performed. The review therefore provides a narrative synthesis of resistance patterns and subtype distribution. Included studies involved children aged 2.1-16 years and sample sizes ranging from 3 to 1080 participants. Resistance mutations were most frequently observed in the NNRTI and NRTI classes, particularly K103N and M184V, whereas protease inhibitor and integrase inhibitor resistance remained less common. HIV-1 subtype distribution showed marked geographic variation, with CRF01_AE predominating in Asia, subtype C in Southern Africa, CRF02_AG and CRF06_cpx in West Africa, and subtype B in Europe and the Americas. These findings highlight the substantial burden of pediatric HIV-1 drug resistance and the need for strengthened surveillance and optimized region-specific treatment strategies.