Mortality and its predictors among human immunodeficiency virus-infected children younger than 15 years receiving antiretroviral therapy in Ethiopia: a systematic review and meta-analysis

BackgroundHuman Immunodeficiency Virus (HIV) continues to be the major cause of childhood deaths, particularly in the sub-Saharan African region. In Ethiopia, though several primary studies have been conducted on the incidence of HIV-related child mortality, the pooled incidence density mortality rate among HIV-positive children is unknown. Therefore, this systematic review and meta-analysis aimed to estimate the pooled incidence density mortality rate among HIV-positive children and identify its associated factors in Ethiopia.MethodsWe browsed PubMed, HINARI, Science Direct, Google Scholar, African Journals Online, and cross-references using different search terms to identify articles. Quality appraisal was done using the Joanna Briggs Institute checklist. Meta-package was used to estimate the pooled incidence of mortality and hazard ratio (HR) of predictors. Heterogeneity was tested using the I-square statistics. Publication bias was tested using a funnel plot visual inspection and Egger’s test. Data was presented using forest plots and tables. The random effect model was used to compute the pooled estimate.ResultsThe overall pooled incidence density mortality rate among HIV-positive children was 2.52 (95% CI: 1.82, 3.47) per 100 child years. Advanced HIV disease (hazard ratio (HR): 3.45, 95% CI (Confidence Interval): 2.64, 4.51), tuberculosis co-infection (HR: 3.19, 95% CI: 2.08, 4.88), stunting (3.22, 95% CI: 2.46, 4.22), underweight (HR: 2.71, 95% CI: 1.72, 4.26), wasting (HR: 4.14, 95% CI: 2.27, 7.58), didn’t receive Isoniazid preventive therapy (HR: 3.33, 95% CI: 2.22, 4.99), anemia (HR: 3.03, 95% CI: 2.52, 3.64), fair or poor antiretroviral therapy adherence (HR: 4.14, 95% CI: 3.28, 5.28) and didn’t receive cotrimoxazole preventive therapy (HR: 3.82, 95% CI: 2.49, 5.86) were factors associated with a higher hazard of HIV related child mortality.ConclusionsThe overall pooled incidence density mortality rate among HIV-positive children was high in Ethiopia as compared to the national strategy target. Therefore, counseling on antiretroviral therapy adherence should be strengthened. Regular monitoring of hemoglobin levels and assessment of nutritional status should be done for all children living with HIV. Moreover, healthcare professionals should follow the national HIV treatment guidelines and provide cotrimoxazole preventive therapy and Isoniazid preventive therapy up on the guidelines for children living with HIV.RegistrationRegistered in PROSPERO with ID: CRD42023486902.

Objectives:The aim of this systematic review and meta-analysis is designed to assess the pooled prevalence and determine risk factors of intestinal parasitic infections among people living with HIV/AIDS on anti-retroviral therapy in Ethiopia.Methods:International databases: PubMed, Web of Science, Cochrane Library, Scopus, PsycINFO, African Journals Online, and Google Scholar were systematically searched. Publication bias was determined using the funnel plot and Egger’s regression tests. Heterogeneity between the studies included in this review was checked by I2 statistic. The DerSimonian and Laird random-effects model was applied to estimate the pooled effect size. Sub-group, meta-regression, and sensitivity analysis were conducted. Overall, meta-analysis was done using Stata version 14 statistical software.Results:Twenty-seven studies with 8946 individuals were included, the estimated pooled prevalence of intestinal parasitic infections among people living with HIV/AIDS on anti-retroviral therapy was 40.24% (95% confidence interval = 33.8–46.6). Based on sub-group analysis, the highest prevalence was observed in the Tigray region 45.7% (95% confidence interval = 7.9–83.5), followed by Oromia region 42.2% (95% confidence interval = 28.8–55.6). Availability of latrine (odds ratio = 26.6, 95% confidence interval = 2.8–15.8), presence of animals at home (odds ratio = 2.7, 95% confidence interval = 1.2–5.8), and source of drinking water (odds ratio = 3.2, 95% confidence interval = 1.3–7.5) were significantly associated with intestinal parasitic infections.Conclusion:These findings indicated that the prevalence of intestinal parasites among people living with HIV/AIDS was high in Ethiopia.

BackgroundPeople living with HIV/AIDS (PLWHA) are frequently confronted with severe social issues such as rejection, abandonment, criticism, and stigma. This would negatively affect their quality of life. Several studies have been conducted so far to assess factors affecting the health-related quality of life among people living with HIV/AIDS who are on antiretroviral therapy (ART) in Ethiopia. However, to our knowledge, there is no previous study that has summarized the results of the studies that investigated health-related quality of life (HRQOL) among PLWHA in Ethiopia. Therefore, the purpose of this review was to estimate the pooled prevalence of HRQOL and its association with social support among people living with HIV/AIDS (PLWHA) on ART in Ethiopia.MethodsA systematic search was carried out using several electronic databases (PubMed, Science Direct, Web of Science, and Cochrane electronic), Google Scholar, Google, and a manual search of the literature on health-related quality of life among people living with HIV/AIDS who are on ART. A Microsoft Excel data extraction sheet was used to extract pertinent data from an individual study. To assess the heterogeneity of primary articles, the Cochrane Q test statistics and the I2 test were carried out, and a random effects meta-analysis was used to estimate the pooled prevalence of HRQOL.ResultOut of the 493 articles reviewed, ten with a total of 3257 study participants were eligible for meta-analysis. The pooled prevalence of HRQOL among people living with HIV/AIDS who are on antiretroviral therapy in Ethiopia was 45.27%. We found that strong perceived social support was significantly associated with higher levels of subjectively perceived HRQOL. PLWHA who were on ART and had good social support were four times more likely to report higher HRQOL when compared to their counterparts [AOR = 4.01, 95% CI 3.07–5.23].ConclusionA substantial number of PLWHA had poor HRQOL in Ethiopia. Social support was significantly associated with HRQOL among people living with HIV/AIDS. Hence, it’s recommended to encourage suitable intervention at every follow-up visit, and psycho-social support is also warranted to improve the quality of life.

The effect of dolutegravir (DTG)-based regimens on reducing attrition from care among women enrolled in the prevention of mother-to-child transmission (PMTCT) care program is unknown. Therefore, this study aimed to compare the incidence of attrition among women exposed to DTG-based with those exposed to efavirenz (EFV)-based first-line antiretroviral therapy (ART) in Ethiopia. An uncontrolled before-and-after study was conducted involving 932 women (with 466 on EFV-based and 466 on DTG-based regimens) who were enrolled in the PMTCT care program from September 2015 to February 2023. The outcome variable was attrition (i.e., maternal death or loss to follow-up before their infants' final HIV status was determined). A Kaplan-Meier estimator was employed to estimate the probability of attrition. The Cox proportional hazards regression model was fitted to identify predictor variables. The adjusted hazard ratio (aHR) with the corresponding 95% confidence interval (CI) was calculated to examine the risk difference in the comparison groups. The cumulative incidence of attrition among women was 5.2% (3.0% for those placed in the DTG-based regimen arm and 7.3% for those placed in the EFV-based regimen arm). Women on DTG-based regimens had a 57% (aHR: 0.43; 95% CI: 0.23-0.80) lower risk of attrition from care compared to those on EFV-based regimens. Women who delivered their infants at home (aHR: 2.35; 95% CI: 1.14-4.85), had poor/fair adherence (aHR: 3.23; 95% CI: 1.62-6.45), had unsuppressed/unknown viral load status (aHR: 2.61; 95% CI: 1.42-4.79), and did not disclose their status to partners (aHR: 2.56; 95% CI: 1.34-4.92) had a higher risk of attrition from PMTCT care compared to their counterparts. The cumulative incidence of attrition among women receiving PMTCT care is optimal. In addition, the risk of attrition among women receiving DTG-based regimens is lower than that among women receiving EFV-based regimens. Thus, DTG-based first-line ART regimen supplementation should be sustained to achieve a national retention target of 95% and above.

BackgroundReliable data on the burden of opportunistic infections (OIs) after the initiation of antiretroviral therapy (ART) is critical for planning health services and reducing OI-related morbidity and mortality. Nevertheless, there has been no nationally representative information on the prevalence of OIs in our country. Therefore, we have undertaken this comprehensive systematic review and meta-analysis to estimate the pooled prevalence, and identify factors associated with the development of OIs in Human Immunodeficiency Virus (HIV)-infected adults receiving ART in Ethiopia.MethodsArticles were searched in international electronic databases. A standardized Microsoft Excel spreadsheet and STATA software version 16 were used for data extraction and analysis, respectively. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist was used to write this report. The random-effect meta-analysis model was used to estimate the pooled effect. The statistical heterogeneity of the meta-analysis was checked. Subgroup and sensitivity analyses were also performed. Publication bias was examined in funnel plots and the nonparametric rank correlation test of Begg and the regression-based test of Egger. Association was expressed through a pooled odds ratio (OR) with a 95% Confidence Interval (CI).ResultsA total of 12 studies with 6,163 study participants were included. The pooled prevalence of OIs was 43.97% [95% CI (38.59, 49.34)]. Poor adherence to ART [OR, 5.90, 95% CI (3.05, 11.40)], under nutrition [OR, 3.70, 95% CI (2.01, 6.80)], CD4 T lymphocyte count <200 cells /μL [OR, 3.23 95% CI (2.06, 5.07)], and advanced World Health Organization (WHO) HIV clinical stages [OR, 4.84 95% CI (1.83, 12.82)] were determinants of OIs.ConclusionThe pooled prevalence of OIs among adults taking ART is high. Poor adherence to ART, under nutrition, a CD4 T lymphocyte count <200 cells /μL, and advanced WHO HIV clinical stages were factors associated with the development of OIs.

BackgroundThe risky sexual behavior of people living with HIV/AIDS (PLWHA) may impose a risk of transmitting the disease to their partners and increase Human Immunodeficiency Virus (HIV) co-infection. This systematic review and meta-analysis aimed to determine the pooled prevalence of risky sexual behavior and associated factors among PLWHA receiving [Antiretroviral Therapy (ART)] in Ethiopia.MethodsTo identify both published and unpublished research articles, systematic searches were performed in PubMed, HINARI, Medline, Science Direct, and Google Scholar databases. The review was carried out following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline. Cross-sectional studies reporting the prevalence of risky sexual practice and its associated factors among PLWHA receiving ART in Ethiopia were included. Two authors independently extracted all necessary data using a standardized data extraction format prepared in Microsoft Excel and exported to STATA version 14 statistical software for further analyses. The Cochrane Q test statistics and I2 test were used to assess the heterogeneity of the studies. Since the included studies exhibited considerable heterogeneity, the random-effects meta-analysis model was computed to estimate the pooled prevalence of risky sexual practice which was determined by dividing the total number of PLWHA with risky sexual practice practices by the total number of PLWHA on ART in the study and multiplied by 100. Furthermore, pooled odds ratio (OR) with 95% confidence interval (CI) was determined for the association between determinant factors and risky sexual practice.ResultIn this study, 2351 articles were identified from different databases, and fifteen articles were selected for final systematic review and meta-analysis. In Ethiopia, the pooled prevalence of risky sexual practices was 43.56% (95% confidence interval (CI):35.51, 51.62). Discussion about safe sex with sexual partner/s [AOR = 0.26, 95% CI: 0.08, 0.92] and having multiple sexual partners [AOR = 1.90, 95% CI: 0.53, 6.84] were factors significantly associated with risky sexual practice in Ethiopia.ConclusionA significant proportion of respondents engaged in risky sexual practices. Multiple sexual partners and a lack of discussion about safe sex are linked to a higher prevalence of the risky sexual practice in Ethiopia. It is critical to raise awareness about safe sexual practices during health education and counselling services and to encourage clients to freely discuss safer sex practices with their sexual partner/s at their antiretroviral therapy (ART) appointments as part of their follow-up care.Protocol registrationThe protocol for this systematic review and meta-analysis was registered at PROSPERO (record ID = CRD42021274600, 25 September 2021).

This study was aimed at developing a risk score prediction model for bacteriologically confirmed tuberculosis (TB) among adults with HIV receiving antiretroviral therapy in Ethiopia. An institutional-based retrospective follow-up study was conducted among 569 adults with HIV on ART. We used demographic and clinical prognostic factors to develop a risk prediction model. Model performance was evaluated by discrimination and calibration using the area under the receiver operating characteristic (AUROC) curve and calibration plot. Bootstrapping was used for internal validation. A decision curve analysis was used to evaluate the clinical utility. Opportunistic infection, functional status, anemia, isoniazid preventive therapy, and WHO clinical stages were used to develop risk prediction. The AUROC curve of the original model was 87.53% [95% confidence interval (CI): 83.88-91.25] and the calibration plot ( P -value = 0.51). After internal validation, the AUROC curve of 86.61% (95% CI: 82.92-90.29%) was comparable with the original model, with an optimism coefficient of 0.0096 and good calibration ( P -value = 0.10). Our model revealed excellent sensitivity (92.65%) and negative predictive value (NPV) (98.60%) with very good specificity (70.06%) and accuracy (72.76%). After validation, accuracy (74.85%) and specificity (76.27%) were improved, but sensitivity (86.76%) and NPV (97.66%) were relatively reduced. The risk prediction model had a net benefit up to 7.5 threshold probabilities. This prognostic model had very good performance. Moreover, it had very good sensitivity and excellent NPV. The model could help clinicians use risk estimation and stratification for early diagnosis and treatment to improve patient outcomes and quality of life.

Objectives:Over the last decades, large number of children living with human immunodeficiency virus (HIV) have been successfully enrolled in care and initiated treatment. However, treatment failure is still a major challenge in the track, missing far too many children. National-level evidence on antiretroviral therapy failure and its associated factors among children receiving highly active antiretroviral therapy is required to alleviate this challenge.Methods:PubMed/Medline, EMBASE, CINAHL, Cochrane library, Google, and Google Scholar databases were used to access eligible studies. This meta-analysis was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In addition, Newcastle–Ottawa Scale quality assessment was applied for critical appraisal. Cochran’s Q statistic, funnel asymmetry plot, and Egger’s test were used to assess heterogeneity and publication bias. Random effect model was computed to explore the pooled burden of treatment failure and its associated factors among children living with HIV. Odds ratio with 95% confidence interval was considered to identify associated factors.Result:The overall pooled prevalence of treatment failure among children living with HIV was 16.6%. Whereas virological, immunological, and clinical failure were 4.49%, 5.41%, and 5.71% respectively, where either of parent is deceased (odds ratio = 2.13, 95% confidence interval: 1.4–3.3), opportunistic infection (odds ratio = 1.67, 95% confidence interval: 1.1–2.5), absence of disclosure of status (odds ratio = 1.6, 95% confidence interval: 1.0–2.5), advanced World Health Organization stage (odds ratio = 4.2, 95% confidence interval: 1.6–10.5), and drug substitution (odds ratio = 2.0, 95% CI: 1.5–2.7) were significantly associated factors.Conclusion:The pooled prevalence of treatment failure among children living with HIV in Ethiopia was lower when compared to most African countries. Accordingly, either prevention or early treatment of opportunistic infection and advanced World Health Organization clinical stages, special care for children whose either parents are deceased, advocating disclosure of status, and avoiding drug substitution as much as possible were still needed to prevent treatment failure.

Background: Treatment failure (TF) among patients receiving antiretroviral therapy (ART) against human immunodeficiency virus (HIV) impacts on treatment outcome and is becoming a public health concern globally. However, magnitude of TF and factors leading to it are poorly defined in the context of Ethiopia. Thus, the aim of this study was to determine the magnitude of TF and assess its determinants among HIV-infected patients on ART in Ethiopia. Methods: A prospective and retrospective study was conducted from March 2016 to 2017. Retrospective clinical and laboratory data were captured from patients’ medical record. Socio-demographics and explanatory variables of participants were collected using pre-tested structured questionnaire and study participants were followed for additional 6 month after baseline viral load has been done to classify virologic failure (VF). Multiple logistic regression was conducted to assess risk factors associated with TF. Statistical significance was set at P-value less than 0.05. Results: A total of 9,284 adults taking ART from a nationally representative 63 health facilities were included in the study. Viral Load Suppression (VLS) (VL1000 copies/ml at baseline of the study were re-suppressed after six months of enhanced adherence and counseling, leading TF among population on ART in Ethiopia to be 983 (11%). Immunologic and clinical failure was significantly improved from 21.5% and 16.5% at ART initiation to 576 (6.2%) and 470 (5.0%) at baseline of the study, respectively. Medication adherence, disclosure of HIV status, missed appointment to ART, history of ART exposure prior to initiation, residency and marital status had significant association with TF. Conclusions: The high level of VLS (88.1%) could explain the success of ART program in Ethiopia towards achieving the UNAIDS global target on viral suppression. TF among population taking ART in Ethiopia is still a public health concern, since 11% of virally failed population is maintained on failed first-line regimen. However, a significant improvement on immunologic and clinical outcome after ART initiation was maintained. Close follow-up of medication adherence, ensuring disclosure of HIV status, regular appointment follow-up to ART could significantly improve the treatment outcome of population on ART in Ethiopia.

ObjectiveTo estimate the pooled attrition rate among HIV-infected children receiving antiretroviral therapy (ART) and identify predictors of attrition in Ethiopia.DesignSystematic review and meta-analysis.Data sourcesPubMed, HINARI, Web of Science, African Journals Online and Google Scholar were searched up to 20 February 2025.Eligibility criteriaCohort studies conducted in Ethiopia that reported attrition from ART and its predictors among children, published as full-length articles in English, were included.Data extraction and synthesisThree independent reviewers extracted data and assessed study quality using the Joanna Briggs Institute checklist for cohort studies. Heterogeneity was assessed using the I² statistic. Publication bias was evaluated with funnel plots and Egger’s test. A random-effects model was applied to estimate the pooled attrition rate.ResultsAmong 1093 studies identified, 14 met the inclusion criteria and were included in the analysis. The pooled attrition rate among HIV-infected children receiving ART was 6.04 per 100 person-years of observation (95% CI 4.90 to 7.44). Anaemia (HR=3.39; 95% CI 2.40 to 4.78), suboptimal ART adherence (HR=2.33; 95% CI 1.39 to 3.89) and underweight status (HR=3.43; 95% CI 2.04 to 5.78) were significantly associated with higher attrition.ConclusionsThe pooled attrition rate among HIV-infected children receiving ART in Ethiopia is relatively low. Nevertheless, enhanced counselling on ART adherence is crucial to further reduce attrition, and special attention should be given to children with anaemia or underweight status.PROSPERO registration numberCRD420251015059.

Impact of Protease Inhibitor-Based Anti-Retroviral Therapy on Outcomes for HIV+ Kidney Transplant Recipients.

Treatment of young HIV-infected children is challenging because of rapid disease progression, high viral loads and few drug options. This review was undertaken to update evidence on the management of young HIV-infected children and to inform the development of the 2013 WHO guidelines for antiretroviral therapy (ART) in low and middle-income countries. A systematic review and meta-analysis. We identified and critically assessed randomized controlled trials that evaluated treatment strategies in perinatally HIV-infected infants and young children (aged <3 years). Eight studies were included. Antiretroviral therapy (ART) initiation in asymptomatic infants led to 74% reduction in mortality or disease progression [hazard ratio 0.36, 95% confidence interval (CI) 0.18-0.74, P = 0.0002]. Regardless of previous exposure to prevention of mother to child transmission (PMTCT), treatment failure at 24 weeks was more likely in children starting nevirapine-based than in those starting lopinavir/ritonavir (lopinavir/r)-based ART (hazard ratio 1.79, 95% CI 1.33-2.41, P = 0.0001). Infants starting lopinavir/r-based ART and substituting lopinavir/r with nevirapine once virologic suppression was achieved were less likely to experience viral load more than 50 copies/ml (hazard ratio 0.62, 95% CI 0.41-0.92, P = 0.02) but more likely to have confirmed virologic failure (>1000 copies/ml) than those remaining on lopinavir/r (hazard ratio 10.19, 95% CI 2.36-43.94, P = 0.002). Children receiving induction-maintenance ART (four-drug NNRTI-based regimen for 36 weeks followed by three-drug ART) showed better short-term immunologic and virologic responses, but no long-term benefits. The only trial comparing continuous ART from infancy with interrupted ART beyond infancy was terminated early because the duration of treatment interruption was less than 3 months in most infants. ART initiation in asymptomatic infants reduces morbidity and mortality. Lopinavir/r-based first-line ART is superior to nevirapine-based regimens in young children, regardless of PMTCT exposure, but lopinavir/r use is challenging. Substituting lopinavir/r with nevirapine following virologic suppression may be feasible where viral load testing is available. Considering current evidence, induction-maintenance and treatment interruption strategies are not recommended. This review contributed to the evidence base for the 2013 WHO guidelines on antiretroviral therapy, which recommend that all children below 3 years start lopinavir/r-based ART and that lopinavir/r can be substituted with nevirapine once sustained virologic suppression is achieved.

Despite effectiveness of antiretroviral therapy in reducing mortality of opportunistic infections among HIV infected children, however tuberculosis (TB) remains a significant cause for morbidity and attributed for one in every three deaths. HIV-infected children face disproportionate death risk during co-infection of TB due to their young age and miniatures immunity makes them more vulnerable. In Ethiopia, there is lack of aggregated data TB and HIV mortality in HIV infected children. We conducted an extensive systematic review of literature using Preferred Reporting of Systematic Review and Meta-Analysis (PRISMA) guideline. Five electronic databases were used mainly Scopus, PubMed, Medline, Web of Science, and Google scholar for articles searching. The pooled proportion of TB was estimated using a weighted inverse variance random-effects meta-regression using STATA version-17. Heterogeneity of the articles was evaluated using Cochran's Q test and I2 statistic. Subgroup analysis, sensitivity test, and Egger's regression were conducted for publication bias. This met-analysis is registered in Prospero-CRD42024502038. In the final met-analysis report, 13 out of 1221 articles were included and presented. During screening of 6668 HIV-infected children for active TB occurrence, 834 cases were reported after ART was initiated. The pooled proportion of active TB among HIV infected children was found 12.07% (95% CI: 10.71-13.41). In subgroup analysis, the Oromia region had 15.6% (95%CI: 10.2-20.6) TB burden, followed by southern Ethiopia 12.8% (95%CI: 10.03-15.67). During meta-regression, missed isoniazid Preventive therapy (IPT) (OR: 2.28), missed contrimoxazole preventive therapy (OR: 4.26), WHO stage III&IV (OR: 2.27), and level of Hgb ≤ 10gm/dl (OR = 3.11.7) were predictors for active TB. The systematic review found a higher proportion of active TB in HIV-infected children in Ethiopia compared to estimated rates in end TB strategy. To prevent premature death during co-infection, implement effective TB screening and cases tracing strategies in each follow up is needed.

PurposeAnemia is a global public health problem, and the majority of human immunodeficiency virus (HIV)-positive people become anemic at some point in the course of the disease. We lack adequate evidence on the magnitude of anemia among children on highly active antiretroviral therapy in Ethiopia and particularly in South Ethiopia. Thus, this study aimed at determining the proportion and associated factors of anemia among children on highly active antiretroviral therapy in Wolaita zone, South Ethiopia.Patients and MethodsA facility-based cross-sectional study was conducted from November to December 2018 on 256 children from 6 months to 14 years of age who were on antiretroviral therapy. Data were collected through an interview with caregivers and review of medical records. CD4+ cell count was analyzed using FACS Calibur, and hemoglobin level was measured with a Hem cue 301 analyzer. Stool samples were examined for the presence of intestinal parasites by direct wet mount technique. Data analyzed with Stata version 14.0 were conveyed in mean and standard deviation of the mean, median and inter-quartile range. Multivariate analysis was carried out to identify independent predictors of the outcome variable. Adjusted odds ratio with 95% confidence interval was reported.ResultsThe proportion of anemia was found to be 38.8%. Co-trimoxazole prophylaxis (AOR=0.45; 95% CI: 0.21, 0.95), caregivers not receiving nutritional counseling (AOR=0.90; 95% CI: 0.01, 0.98) and presence of intestinal parasites (AOR=3.10; 95% CI: 1.39, 6.88) were associated with anemia.ConclusionThe proportion of anemia found in this study is a moderate public health problem. Health education programs in antiretroviral therapy clinics should be targeted at appropriate dietary practice, and appropriate hand washing and other hygienic practices to prevent intestinal parasitic infections. Co-trimoxazole prophylaxis should be given to all eligible children based on the recommendation.

There is limited data on virologic outcome and its correlates among HIV-infected children in resource-limited settings. We investigated rate and correlates of virologic outcome among treatment naïve HIV-infected Ethiopian children initiating cART, and were followed prospectively at baseline, 8, 12, 24 and 48 weeks using plasma viral load, clinical examination, laboratory tests and pretreatment HIV drug resistance (PDR) screening. Virologic outcome was assessed using two endpoints–virological suppression defined as having “undetectable” plasma viral load < 150 RNA copies/mL, and rebound defined as viral load ≥150 copies/mL after achieving suppression. Cox Proportional Hazards Regression was employed to assess correlates of outcome. At the end of follow up, virologic outcome was measured for 110 participants. Overall, 94(85.5%) achieved virological suppression, of which 36(38.3%) experienced virologic rebound. At 48 weeks, 9(8.2%) children developed WHO-defined virological treatment failure. Taking tenofovir-containing regimen (Hazard Ratio (HR) 3.1-[95% confidence interval (95%CI) 1.0–9.6], p = 0.049) and absence of pretreatment HIV drug resistance (HR 11.7-[95%CI 1.3–104.2], p = 0.028) were independently associated with earlier virologic suppression. In conclusion, PDR and cART regimen type correlate with rate of virologic suppression which was prominent during the first year of cART initiation. However, the impact of viral rebound in 38.3% of the children needs evaluation.