BackgroundAbacavir is one of the recommended nucleoside reverse transcriptase inhibitors (NRTIs) for the treatment of HIV infections among children and adolescents. However, there are concerns that the antiviral efficacy of abacavir might be low when compared to other NRTIs especially among children. There are also concerns that abacavir use may lead to serious adverse events such as hypersensitivity reactions and has potential predisposition to developing cardiovascular diseasesMethodsWe searched four electronic databases, four conference proceedings and two clinical trial registries in August 2014, without language restrictions. Experimental and observational studies with control groups that examined the efficacy and safety of abacavir-containing regimens in comparison with other NRTIs as first-line treatment for HIV-infected children and adolescents aged between one month and eighteen years were eligible. Two authors independently screened search results, extracted data and assessed the risk of bias of included studies using a pre-specified, standardised data extraction form and validated risk of bias tools. We also assessed the quality of evidence per outcome with the GRADE tool.ResultsWe included two randomised controlled trials (RCTs) and two analytical cohort studies with a total of 10,595 participants. Among the RCTs we detected no difference in virologic suppression after a mean duration of 48 weeks between abacavir- and stavudine-containing regimens (2 trials; n = 326: RR 1.28; 95 % CI 0.67–2.42) with significant heterogeneity (P = 0.02; I2 = 81 %). We also found no significant differences between the two groups for adverse events and death. After five years of follow-up, virologic suppression improved with abacavir (1 trial; n = 69: RR 1.96; 95 % CI 1.11–3.44). For cohort studies, we detected that the virologic suppression activity of abacavir was less effective than stavudine in both the lopinavir/ritonavir (1 study, n = 2165: RR 0.79, 95 % CI 0.67–0.92) and efavirenz sub-groups (1 study, n = 3204: RR 0.79, 95 % CI 0.67–0.92) respectively. The quality of evidence from RCTs was moderate for virologic suppression but low for death and adverse events, while that of cohort studies was low for all three these outcomes.ConclusionsAvailable evidence showed little or no difference between abacavir-containing regimen and other NRTIs regarding efficacy and safety when given to children and adolescents as a first-line antiretroviral therapy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1183-6) contains supplementary material, which is available to authorized users.

Paediatric HIV-infected patients have higher risk of developing resistance to antiretroviral drugs, and from public health perspective, drug resistance remains a limiting factor for effective management of HIV infection in children. We reviewed the current evidences available on the antiretroviral treatment and resistance patterns in HIV-infected children. Prevalence of HIV drug resistance varied among the three main classes of antiretroviral drugs, namely nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors and protease inhibitors in both treatment naïve and treatment-experienced children in different countries. Most of the patients with extensive triple-class drug-resistant mutations were found to be considerably exposed to the three main classes of antiretroviral agents. Identification of genetic factors linked with susceptibility to perinatal transmission of HIV may be key in understanding the development of resistance due to waning antiviral effectiveness. Children who were less likely to achieve viral re-suppression were more likely to have resistance mutations. Newer drugs such as etravirine can be used as alternatives in case of resistance to efavirenz while newly developed diagnostic method such as next-generation sequencing is a platform for improving quality of detections especially minor variant drug resistance mutations.

Objective: The objective of this study was to describe the current macro-and micronutrient intake of children (both boys and girls) in two selected communities in the Breede Valley, Worcester. Design: This was a quantitative cross-sectional study. Setting: The study focused on two disadvantaged communities in Worcester (Avian Park and Zweletemba) in the Breede Valley, Western Cape province. Subjects: The study subjects were 248 children (Avian Park, n = 117; Zweletemba, n = 131) aged 12-36 months. Method: The macro-and micronutrient intake of the children was determined using a validated, interviewer-administered quantitative food frequency questionaire, and compared against the estimated average requirement (EAR) and adequate intake (AI) of nutrients. The nutrient adequacy ratio was calculated, as well as percentage deviation from the EAR and AI. Results: More than 20% of the children had a calcium and folate intake that deviated by more than 50% below the EAR in both communities and for both genders. More participants in Zweletemba had an intake that deviated by more than 50% above the EAR and AI, compared to Avian Park, for carbohydrate, thiamine, niacin and iron. Conclusion: With the exception of folate, calcium and selenium, the average reported nutrient intake of the children (boys and girls) in both the communities was adequate.