ArticleAIDS (London, England)2018
HIV-1 second-line failure and drug resistance at high-level and low-level viremia in Western Kenya.
Article in AIDS (London, England), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 3 of them syntheses that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
28 citing papers in PubMed, 3 syntheses or guidelines pooled it, 42 citations in OpenAlex.
- The viral load monitoring cascade in HIV treatment programmes in sub-Saharan Africa: a systematic review.BMC public health · 2024Pooled it
- The risk of sexual transmission of HIV in individuals with low-level HIV viraemia: a systematic review.Lancet (London, England) · 2023Pooled it
- Viral load monitoring for people living with HIV in the era of test and treat: progress made and challenges ahead - a systematic review.BMC public health · 2022Pooled it
- High frequency of HIV-1 drug resistance among individuals with persistent low-level viremia during first-line antiretroviral therapy in Uganda.BMC infectious diseases · 2026Article
- Characterization of human immunodeficiency virus drug-resistance mutations among individuals with low-level-viremia in low-income and middle-income countries: A meta-analysis.World journal of virology · 2026Article
- Efficacy of dolutegravir-based therapy in achieving virological suppression in PLHIV in low- and middle-income countries: real-world evidence from a large clinical cohort in Cameroon.BMC infectious diseases · 2026Article
- Article
- Treatment of Advanced HIV in the Modern Era.Drugs · 2025Review
- HIV drug resistance, early treatment outcomes and impact of guidelines compliance after protease inhibitor-based second-line failure in a dedicated resistance clinic in western Kenya: a retrospective cohort study.Journal of the International AIDS Society · 2025Article
- Risk Factors Associated with Virological Failure in HIV Patients with Low Level Viremia: A Retrospective Study.Infection and drug resistance · 2025Article
- Article
- Incidence of low-level viremia and its impact on virologic failure among people living with HIV who started an integrase strand transfer inhibitors: a longitudinal cohort study.BMC infectious diseases · 2024Article
- We should not stop considering HIV drug resistance testing at failure of first-line antiretroviral therapy.The lancet. HIV · 2023Review
- HIV Virologic Failure among Patients with Persistent Low-Level Viremia in Nairobi, Kenya: It Is Time to Review the >1000 Virologic Failure Threshold.BioMed research international · 2023Article
- Factors associated with adherence and viral suppression among patients on second-line antiretroviral therapy in an urban HIV program in Kenya.SAGE open medicine · 2023Article
- Added Value of Next Generation over Sanger Sequencing in Kenyan Youth with Extensive HIV-1 Drug Resistance.Microbiology spectrum · 2022Article
- Low-frequency HIV-1 drug resistance mutations in antiretroviral naïve individuals in Botswana.Medicine · 2022Article
- HIV-1 drug resistance genotyping success rates and correlates of Dried-blood spots and plasma specimen genotyping failure in a resource-limited setting.BMC infectious diseases · 2022Article
- HIV-1 drug resistance mutations among individuals with low-level viraemia while taking combination ART in Botswana.The Journal of antimicrobial chemotherapy · 2022Article
- Comparative Effectiveness of Interventions to Improve the HIV Continuum of Care and HIV Preexposure Prophylaxis in Kenya: A Model-Based Analysis.The Journal of infectious diseases · 2022Article
Corrections and comments
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Authors and funding
15 authors at 5 institutions in 2 countries.
Funding
Abstract
objectiveCharacterize failure and resistance above and below guidelines-recommended 1000 copies/ml virologic threshold, upon second-line failure.
designCross-sectional study.
methodsKenyan adults on lopinavir/ritonavir-based second-line were enrolled at AMPATH (Academic Model Providing Access to Healthcare). Charts were reviewed for demographic/clinical characteristics and CD4/viral load were obtained. Participants with detectable viral load had a second visit and pol genotyping was attempted in both visits. Accumulated resistance was defined as mutations in the second, not the first visit. Low-level viremia (LLV) was detectable viral load less than 1000 copies/ml. Failure and resistance associations were evaluated using logistic and Poisson regression, Fisher Exact and t-tests.
resultsOf 394 participants (median age 42, 60% women, median 1.9 years on second-line) 48% had detectable viral load; 21% had viral load more than 1000 copies/ml, associated with younger age, tuberculosis treatment, shorter time on second-line, lower CD4count/percentage, longer first-line treatment interruption and pregnancy. In 105 sequences from the first visit (35 with LLV), 79% had resistance (57% dual-class, 7% triple-class; 46% with intermediate-to-high-level resistance to ≥1 future drug option). LLV was associated with more overall and NRTI-associated mutations and with predicted resistance to more next-regimen drugs. In 48 second-visit sequences (after median 55 days; IQR 28-33), 40% accumulated resistance and LLV was associated with more mutation accumulation.
conclusionHigh resistance upon second-line failure exists at levels above and below guideline-recommended virologic-failure threshold, impacting future treatment options. Optimization of care should include increased viral load monitoring, resistance testing and third-line ART access, and consideration of lowering the virologic failure threshold, though this demands further investigation.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.