Impact of first-line antiretroviral therapy choice on adverse drug reactions in children with HIV infection: a retrospective cohort study in southwest China

Antiretroviral therapy (ART) is essential in managing children with human immunodeficiency virus (HIV) infection, but is often complicated by adverse drug reactions (ADRs), which can significantly impact therapeutic outcomes. This study investigates ADRs in 375 children with HIV receiving zidovudine (AZT)- or abacavir (ABC)-based ART regimens, using Kaplan-Meier, Cox regression analyses to evaluate ADR incidences, and propensity score matching (PSM) to address confounders. We found ADRs occurred in 21.9% of the cohort. Incidence was significantly higher with the ABC-based regimen (31.2%) versus the AZT-based regimen (17.2%). Most ADRs-primarily gastrointestinal-emerged within the first month of ART. Cox regression analysis confirmed ABC-based regimen nearly tripled the ADR risk (adjusted hazard ratio [aHR] = 2.987, <i>P</i> < 0.001). Notably, children at advanced WHO clinical stages (III-IV) on the ABC-based regimen faced even greater risk (aHR = 3.190, <i>P</i> = 0.005) compared to earlier stages (I-II). These results underscore the need for regimen customization based on disease severity to improve safety and efficacy in pediatric HIV treatment, informing optimized ART protocols and personalized strategies.