The increase in treatments for people affected by HIV virus has led to a global reduction of new childhood infections. Nonetheless, particularly in settings with limited resources, the level of emergency is still high, despite the efforts to expand access to combined antiretroviral therapy (cART), One of the main causes of the still high percentage of HIV-infected children is delay in identifying treatment failure to then go to the second line of treatment. This delay causes drug resistance and a resulting overall difficult in combating the infection.

Starting from a comparative analysis of therapies implemented in hospitals in Beira, Mozambique and Nsambya, Uganda between 2005 and 2009 with the support of the NGO Doctors for Africa CUAMM and the Associazione Casa Accoglienza alla Vita Padre Angelo, the authors of the article, published in 2014 in the Journal of the Pediatric Infectious Diseases Society, sought to identify cART failure predictors in children in two situations.

Treatment failure is due to factors such as being simultaneously infected with tuberculosis or other WHO stage 4 defining diseases. Reasons for delay in moving to the second line of treatment are difficult to identify, which is to say that it is not clear if the responsibility lies with the healthcare personnel or if it is objectively difficult to identify failures. There are also differences between the two countries, such as the age of the children, the stage of the disease and number of visits. Nonetheless, the conclusion the authors reach by presenting data collected is essential for simplifying clinical and immunological criteria to identify treatment failures and move quickly to the next stage. This is the only way to increase cART effectiveness.