Global Cohort Data Bolster Confidence in Dolutegravir for Pediatric HIV Care

One of the defining strengths of this analysis, presented at the Conference on Retroviruses and Opportunistic Infections 2026, is its scale and geographic diversity. Drawing on cohort data from the International Epidemiology Databases to Evaluate AIDS (IeDEA), spanning West, East, Central, and Southern Africa, the Asia-Pacific, and Latin America and the Caribbean, the study captures growth trajectories from real-world clinical settings that are home to more than 90% of the world's children and adolescents living with HIV, who have been substantially underrepresented in prior research.

When asked what first stood out upon reviewing the results, both researchers pointed immediately to consistency. Julie Jesson, PhD, a researcher in epidemiology and biostatistics at the University of Toulouse, noted that regardless of how the data were sliced, by age, sex, or region, the same pattern emerged: modest early weight gain followed by a clear plateau, with no sustained excess gain extending into the second year.

Juan D. Medina, MD, MPH, research engineer at the Institut Necker Enfants Malades in Paris, echoed this, describing the visual and statistical clarity of the plateau as the finding that was most striking and most informative in shaping the study's conclusions.

Both researchers emphasized how much the global scope of the cohort adds to the field. Most prior pediatric dolutegravir studies have been conducted in high-income countries in Europe and North America—a body of literature that, as Medina noted, may be significantly biased by geography and does not reflect the lived realities of the vast majority of affected children. This study's ability to draw on large-scale programmatic data from low- and middle-income settings is a meaningful corrective.

On the question of regional differences, Jesson highlighted West Africa as a notable outlier, where initial post-dolutegravir body mass index-for-age z-score gains were steeper than in other regions, likely reflecting the lowest baseline nutritional status at dolutegravir start. She attributed this to a combination of local nutritional challenges and potential delays in HIV diagnosis and treatment initiation.

Importantly, however, West African patients ultimately caught up with other regions and showed the same plateau pattern, which the researchers viewed as further evidence of return-to-health rather than a cause for concern. Medina added that regional differences in health system infrastructure and nutritional policy warrant continued investigation in future studies.