ArticleThe Lancet. Global health2022
Low-level viraemia among people living with HIV in Nigeria: a retrospective longitudinal cohort study.
Article in The Lancet. Global health, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.
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Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it, 31 citations in OpenAlex.
- Prevalence of low-level viremia and related influencing factors among people living with HIV in China: a systematic review and meta-analysis.Frontiers in public health · 2025Pooled it
- Impact of HIV-1 low-level viremia on virologic and immunologic failure during antiretroviral therapy: a retrospective cohort study from 2005 to 2023 in Qinzhou City, Guangxi, China.AIDS research and therapy · 2026Article
- 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
- Virologic outcomes among people living with HIV on dolutegravir-based antiretroviral therapy in Kenya, 2018-2024: a comparison retrospective longitudinal analysis.The Lancet regional health. Africa · 2026Article
- Maintain, not obtain: rethinking HIV care in sub-Saharan Africa in the era of dolutegravir.Frontiers in public health · 2026Article
- Article
- Low-level viremia in people with HIV in Ethiopia is associated with subsequent lack of viral suppression and attrition from care.Global health action · 2025Article
- Low-level viremia and subsequent virologic failure among people living with HIV: a retrospective cohort study in China.BMC infectious diseases · 2025Article
- HIV-1 Low-Level Viremia Predicts Viral Failure in Participants on Antiretroviral Therapy in the Swiss HIV Cohort Study.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Article
- A Guide to the Evolving Clinical Landscape of Low-Level Viremia Among Persons with HIV in the Modern Treatment Era.Current HIV/AIDS reports · 2025Review
- Impact of low-level viremia on HIV non-viral load suppression in low and middle-income countries.Annals of medicine and surgery (2012) · 2025Review
- Prevalence of drug resistance mutations in low-level viremia patients under antiretroviral therapy in Southwestern China: a cross-sectional study.The Journal of antimicrobial chemotherapy · 2025Article
- Effect of Machine Learning on Risk Stratification for Antiretroviral Treatment Failure in People Living with HIV.Infection and drug resistance · 2025Article
- Article
- Detectable Virological Load and Associated Factors among People Living with HIV on Antiretroviral Treatment: A Retrospective Study.Pathogens (Basel, Switzerland) · 2024Article
- Clinical Relevance of Human Immunodeficiency Virus Low-level Viremia in the Dolutegravir era: Data From the Viral Load Cohort North-East Lesotho (VICONEL).Open forum infectious diseases · 2024Article
- Temporal dynamics and drivers of durable HIV viral load suppression and persistent high- and low-level viraemia during Universal Test and Treat scale-up in Uganda: a population-based study.Journal of the International AIDS Society · 2024Article
- 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
- Field study to determine the reliability of HIV viral load results shows minimal impact of delayed testing in South Africa.African journal of laboratory medicine · 2024Article
- HIV risk behaviour, viraemia, and transmission across HIV cascade stages including low-level viremia: Analysis of 14 cross-sectional population-based HIV Impact Assessment surveys in sub-Saharan Africa.PLOS global public health · 2024Article
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22 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundHIV transmission can occur with a viral load of at least 200 copies per mL of blood and low-level viraemia can lead to virological failure; the threshold level at which risk for virological failure is conferred is uncertain. To better understand low-level viraemia prevalence and outcomes, we analysed retrospective longitudinal data from a large cohort of people living with HIV on antiretroviral therapy (ART) in Nigeria.
methodsIn this retrospective cohort study using previously collected longitudinal patient data, we estimated rates of virological suppression (≤50 copies per mL), low-level viraemia (51-999 copies per mL), virological non-suppression (≥1000 copies per mL), and virological failure (≥2 consecutive virological non-suppression results) among people living with HIV aged 18 years and older who initiated and received at least 24 weeks of ART at 1005 facilities in 18 Nigerian states. We analysed risk for low-level viraemia, virological non-suppression, and virological failure using log-binomial regression and mixed-effects logistic regression.
findingsAt first viral load for 402 668 patients during 2016-21, low-level viraemia was present in 64 480 (16·0%) individuals and virological non-suppression occurred in 46 051 (11·4%) individuals. Patients with low-level viraemia had increased risk of virological failure (adjusted relative risk 2·20, 95% CI 1·98-2·43; p<0·0001). Compared with patients with virological suppression, patients with low-level viraemia, even at 51-199 copies per mL, had increased odds of low-level viraemia and virological non-suppression at next viral load; patients on optimised ART (ie, integrase strand transfer inhibitors) had lower odds than those on non-integrase strand transfer inhibitors for the same low-level viraemia range (eg, viral load ≥1000 copies per mL following viral load 400-999 copies per mL, integrase strand transfer inhibitor: odds ratio 1·96, 95% CI 1·79-2·13; p<0·0001; non-integrase strand transfer inhibitor: 3·21, 2·90-3·55; p<0·0001).
interpretationPatients with low-level viraemia had increased risk of virological non-suppression and failure. Programmes should revise monitoring benchmarks and targets from less than 1000 copies per mL to less than 50 copies per mL to strengthen clinical outcomes and track progress to epidemic control.
fundingNone.
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