ArticleThe lancet. HIV2020
Virological failure, HIV-1 drug resistance, and early mortality in adults admitted to hospital in Malawi: an observational cohort study.
Article in The lancet. HIV, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 55 papers, 4 of them syntheses that pooled it.
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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.
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Who cites it
55 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Pooled it
- HIV-1 Antiretroviral Drug Resistance in Mozambique: A Systematic Review and Meta-Analysis.Viruses · 2024Pooled it
- Use of hospital services by patients with chronic conditions in sub-Saharan Africa: a systematic review and meta-analysis.Bulletin of the World Health Organization · 2023Pooled it
- Men missing from the HIV care continuum in sub-Saharan Africa: a meta-analysis and meta-synthesis.Journal of the International AIDS Society · 2022Pooled it
- Point-of-care CD4 testing: Differentiated care for the most vulnerable.Journal of global health · 2022Trial
- Resistance Testing for Management of HIV Virologic Failure in Sub-Saharan Africa : An Unblinded Randomized Controlled Trial.Annals of internal medicine · 2021Trial
- 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
- Incidence, survival, and risk factors for first-line antiretroviral therapy failure among adults on ART follow-up in health facilities in Southwest Shoa, Oromia, Ethiopia, 2023: a retrospective cohort study.BMC infectious diseases · 2026Article
- HIV-1 drug resistance and associated risk factors in patients with antiretroviral therapy failure in Chongqing, China, 2019-2023.PloS one · 2026Article
- Virological failure and risk factors among people living with HIV taking second-line ART in Addis Ababa, Ethiopia.PloS one · 2026Article
- Pharmacokinetic-pharmacodynamic modeling of a highly potent and broadly neutralizing anti-CD4 trimeric nanobody to inhibit HIV-1 infection.Microbiology spectrum · 2025Article
- Prevalence and factors associated with HIV drug resistance among adult persons living with HIV/AIDS in nine countries of Sub-Saharan Africa using population-based HIV impact assessments: 2015-2019.BMC public health · 2025Article
- Viral failure and associated factors in adults on second line antiretroviral therapy in public hospitals of Harari Region and Dire Dawa administration, Eastern Ethiopia.Journal of public health research · 2025Article
- Drug resistance mutations among people living with HIV and ART failure in Bangladesh: a cross-sectional study.The Lancet regional health. Southeast Asia · 2025Article
- HIV-1 RNA in Large and Small Plasma Extracellular Vesicles: A Novel Parameter for Monitoring Immune Activation and Virological Failure.Journal of medical virology · 2025Article
- HIV Viral Re-Suppression on Second-Line ART in Southern Zimbabwe.International journal of environmental research and public health · 2025Article
- Robustness of viral load over CD4 cell count in measuring the quality of life of people with HIV at second line regimen in Amhara region.Scientific reports · 2025Article
- Hospitalization outcomes in people living with HIV on Dolutegravir-based regimen in Mwanza, Tanzania: a comparative cohort.AIDS research and therapy · 2025Article
- Exploring survival rates in HIV-infected Ethiopian children receiving HAART: a retrospective cohort study.BMJ paediatrics open · 2025Article
- HIV multidrug class resistance prediction with a time sliding anchor approach.Bioinformatics advances · 2025Article
Corrections and comments
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Authors and funding
12 authors.
Funding
Abstract
backgroundAntiretroviral therapy (ART) scale-up in sub-Saharan Africa combined with weak routine virological monitoring has driven increasing HIV drug resistance. We investigated ART failure, drug resistance, and early mortality among patients with HIV admitted to hospital in Malawi.
methodsThis observational cohort study was nested within the rapid urine-based screening for tuberculosis to reduce AIDS-related mortality in hospitalised patients in Africa (STAMP) trial, which recruited unselected (ie, irrespective of clinical presentation) adult (aged ≥18 years) patients with HIV-1 at admission to medical wards. Patients were included in our observational cohort study if they were enrolled at the Malawi site (Zomba Central Hospital) and were taking ART for at least 6 months at admission. Patients who met inclusion criteria had frozen plasma samples tested for HIV-1 viral load. Those with HIV-1 RNA of at least 1000 copies per mL had drug resistance testing by ultra-deep sequencing, with drug resistance defined as intermediate or high-level resistance using the Stanford HIVDR program. Mortality risk was calculated 56 days from enrolment. Patients were censored at death, at 56 days, or at last contact if lost to follow-up. The modelling strategy addressed the causal association between HIV multidrug resistance and mortality, excluding factors on the causal pathway (most notably, CD4 cell count, clinical signs of advanced HIV, and poor functional and nutritional status).
findingsOf 1316 patients with HIV enrolled in the STAMP trial at the Malawi site between Oct 26, 2015, and Sept 19, 2017, 786 had taken ART for at least 6 months. 252 (32%) of 786 patients had virological failure (viral load ≥1000 copies per mL). Mean age was 41·5 years (SD 11·4) and 528 (67%) of 786 were women. Of 237 patients with HIV drug resistance results available, 195 (82%) had resistance to lamivudine, 128 (54%) to tenofovir, and 219 (92%) to efavirenz. Resistance to at least two drugs was common (196, 83%), and this was associated with increased mortality (adjusted hazard ratio 1·7, 95% CI 1·2-2·4; p=0·0042).
interpretationInterventions are urgently needed and should target ART clinic, hospital, and post-hospital care, including differentiated care focusing on patients with advanced HIV, rapid viral load testing, and routine access to drug resistance testing. Prompt diagnosis and switching to alternative ART could reduce early mortality among inpatients with HIV.
fundingJoint Global Health Trials Scheme of the Medical Research Council, UK Department for International Development, and Wellcome Trust.
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