Mapping HIV-1 Genetic Diversity and Transmission Dynamics in Central African Children: Persistent Challenges and Molecular Complexity

Significant advancements in, and increased access to, antiretroviral therapy (ART) have substantially reduced the risk of mother-to-child transmission (MTCT) of HIV. However, antiretroviral drug resistance (HIVDR) is a serious challenge affecting both adults and children. Because of high HIV prevalence and genetic diversity, Central Africa is considered the epicenter of the epidemic. Yet information on drug resistance profiles and clinical efficacy of newer antiretroviral agents among children is limited compared to adult cohorts. Not to mention that several countries of the subregion, including Gabon, Chad, and São Tomé and Príncipe, lack updated epidemiological data. This article aims to provide an overview of HIV prevention of mother-to-child transmission (PMTCT), focusing on four key elements: prevalence rates; associated risk factors; molecular characterization of pediatric HIV; and virological response to antiretroviral therapy in Central Africa. We have gathered studies published between 2014 and 2026 across PubMed and Research Gate databases and AJOL. The synthesized data reveal high genetic variability of HIV and a dominant CRF02AG variant within the considered populations. The results of this study indicate a range of virological failure rates in the pediatric population on ART for at least six months, ranging from 11.1% to 89.1%. These rates are attributed to a high frequency of resistance-associated mutations (RAMs) and suboptimal adherence to antiretroviral treatment. The main determinants of non-adherence are social stigma, geographic barriers (distance from specialized care centers) and orphan status. Strengthened virological and molecular surveillance programs must be implemented in Central Africa to ensure optimal care for pregnant women, children, and adolescents. Addressing these gaps is imperative in order to bridge the gap between the current epidemiological profile and the WHO’s goals for the elimination of pediatric HIV.