{
  "abstract": "Background: HIV-1 drug resistance (HIVDR) complicates antiretroviral therapy (ART) in children and adolescents living with HIV (CALWH), particularly in high-prevalence areas such as KwaZulu-Natal, South Africa. This study describes trends in HIVDR and patterns by drug class and geographic location among ART-experienced CALWH in KwaZulu-Natal.\n\nMethods: We analysed 914 routine HIV-1 genotypic resistance tests (GRTs) obtained between January 2018 and June 2022 from 0–17-year-old CALWH, integrating facility-linked Geographic Information Systems (GIS) coordinates for geospatial, descriptive and logistic regression analyses.\n\nResults: Here we show that 80.96% (740/914) of GRTs from CALWH (median age 13, interquartile range 7-15 years) across 114 facilities demonstrate HIVDR. Of the 740 individuals with HIVDR, 609 (82.30%) had non-nucleoside reverse transcriptase inhibitor (NNRTI) mutations, and among them, 32 (5.25%) were on NNRTI treatment. Additionally, 525 (70.95%) had nucleoside reverse transcriptase inhibitor (NRTI) mutations, and 181 (24.46%) had major protease inhibitor (PI) mutations. One in every 6 GRTs with HIVDR (129/740; 17.43%) have triple-class NRTI, NNRTI and PI mutations. When analysed by age, ~9 in every 10 GRTs from CALWH aged 0-9 years (237/257, 92.22%) have HIVDR, compared to 76.56% (503/657) aged 10-17 years (OR = 3.63, 95% CI: 2.22-5.93, p < 0.001). GIS-interpolation maps show potential-low-level resistance to tenofovir, low-to-intermediate-level resistance to abacavir (high-level in northern localities) and intermediate-to-high-level resistance to lamivudine, nevirapine and efavirenz.\n\nConclusions: Routine GRTs demonstrate high HIVDR prevalence among younger children, while ART susceptibility maps show overall uniformity with variations in certain regions, such as northern KwaZulu-Natal localities. GIS-linked real-time monitoring of HIVDR is crucial to assess the impact of the revised HIV-1 treatment guidelines for CALWH in South Africa.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Virology, School of Medicine, University of KwaZulu-Natal, Durban, South Africa",
    "Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban, South Africa",
    "Department of Paediatrics, University of KwaZulu-Natal, Durban, South Africa",
    "School of Pathology, University of Witwatersrand & National Health Laboratory Service, Johannesburg, South Africa",
    "Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa",
    "South African Medical Research Council (SAMRC), CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa",
    "Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD USA"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Lilishia Gounder",
      "orcid": "0000-0003-1060-9170"
    },
    {
      "affs": [
        2
      ],
      "name": "Moherndran Archary"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Aabida Khan"
    },
    {
      "affs": [
        0
      ],
      "name": "Kerusha Govender"
    },
    {
      "affs": [
        0,
        3
      ],
      "name": "Raveen Parboosing",
      "orcid": "0000-0002-5476-1011"
    },
    {
      "affs": [
        4,
        5
      ],
      "name": "Kogieleum Naidoo"
    },
    {
      "affs": [
        0,
        4,
        6
      ],
      "name": "Benjamin Chimukangara"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/fdf0xw1shrefj.bib",
  "cited_by": 0,
  "doi": "10.1038/s43856-026-01770-9",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13720034/",
  "id": "fdf0xw1shrefj",
  "issns": [
    "2730-664X"
  ],
  "landing_url": "https://doi.org/10.1038/s43856-026-01770-9",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Article"
    ],
    [
      "openalex",
      "2725|HIV/AIDS drug development and treatment"
    ]
  ],
  "openalex": "W7167615940",
  "pdf_url": "https://www.nature.com/articles/s43856-026-01770-9_reference.pdf",
  "pmcid": "PMC13720034",
  "pmid": "42414521",
  "published": "2026-07-07",
  "publisher": "Nature Publishing Group",
  "ris": "https://research.draconitic.com/paper/fdf0xw1shrefj.ris",
  "sources": [
    {
      "first_seen": "2026-11-02T12:23:53Z",
      "native_id": "PMC13720034",
      "source": "pmc",
      "url": "https://doi.org/10.1038/s43856-026-01770-9"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2725|HIV/AIDS drug development and treatment",
      "subfield": "infectious-disease"
    }
  ],
  "title": "Geospatial analysis reveals similar HIV-1 drug resistance patterns among antiretroviral therapy-experienced children and adolescents (0-17 years) of South Africa",
  "title_text": "Geospatial analysis reveals similar HIV-1 drug resistance patterns among antiretroviral therapy-experienced children and adolescents (0-17 years) of South Africa",
  "type": "peer-reviewed",
  "updated_at": "2026-11-03T12:21:00Z",
  "url": "https://research.draconitic.com/paper/fdf0xw1shrefj",
  "venue": "Communications Medicine",
  "versions": []
}