{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T10:37:09Z","timestamp":1788518229977,"version":"build-2803163510"},"reference-count":37,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T00:00:00Z","timestamp":1747008000000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Viral load (VL) of 1000 copies\/ml or greater is commonly used to define virologic failure (VF) in children and adolescents living with HIV (CALHIV) in low\u2010 and middle\u2010income countries (LMICs). However, evidence in adults suggests that low\u2010level viraemia (LLV) (VL 50\u2013999 copies\/ml) increases the risk of subsequent VF. There is limited research on LLV in CALHIV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study retrospectively reviewed VL data from Baylor College of Medicine Children's Foundation\u2014Tanzania (sites in Mbeya and Mwanza) collected between January 2015 and December 2022. CALHIV (0\u221219 years) on antiretroviral therapy for \u22656 months with at least one VL &lt;50 copies\/ml plus \u22652 subsequent VLs were included. VF was defined as both VL \u22651000 and \u2265200 copies\/ml. Multivariable Cox regression models were used to assess the association between LLV and VF, reporting adjusted hazard ratios (aHR) with 95% confidence intervals (CI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 2618 CALHIV included in the outcome analysis (median age 13.2 years, 52.5% female), 81.9% were on first\u2010line dolutegravir\u2010based regimens and LLV was found in 40.5%. CALHIV with LLV had an increased risk of VF with aHRs of 1.63 (CI 1.38\u22121.91) (VL \u22651000 copies\/ml) and 3.85 (3.33, 4.46) (VL \u2265200 copies\/ml). When stratifying by LLV (50\u2212199, 200\u2013399 and 400\u2013999 copies\/ml), all levels were associated with increased risk for VF (VL \u22651000 copies\/ml) with aHRs of 1.39 (1.13, 1.69), 1.69 (1.33, 2.16) and 2.03 (1.63, 2.53). When VF was defined as VL \u2265200 copies\/ml, the corresponding aHRs were 1.41 (1.15, 1.72), 7.99 (6.68, 9.57) and 9.37 (7.85, 11.18).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>LLV is associated with a greater risk of VF in CALHIV. The risk of VF increases with higher levels of LLV. This study provides further evidence for revising guidelines in LMICs that define VF as VL \u22651000 copies\/ml.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.26474","type":"journal-article","created":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T01:45:52Z","timestamp":1747100752000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Low\u2010level viraemia as a risk factor for virologic failure in children and adolescents living with HIV on antiretroviral therapy in Tanzania: a multicentre, retrospective cohort study"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6250-8984","authenticated-orcid":false,"given":"Kevin P.","family":"McKenzie","sequence":"first","affiliation":[{"name":"Department of Pediatrics Baylor College of Medicine  Houston Texas USA"},{"name":"Texas Children's Global Health Network  Houston Texas USA"},{"name":"Baylor College of Medicine Children's Foundation \u2013 Tanzania  Mbeya Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5059-4404","authenticated-orcid":false,"given":"Duc T.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilian B.","family":"Komba","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine Children's Foundation \u2013 Tanzania  Mbeya Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eunice W.","family":"Ketang'enyi","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine Children's Foundation \u2013 Tanzania  Mwanza Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neema E.","family":"Kipiki","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine Children's Foundation \u2013 Tanzania  Mwanza Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evance N.","family":"Mgeyi","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine Children's Foundation \u2013 Tanzania  Mbeya Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lumumba F.","family":"Mwita","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine Children's Foundation \u2013 Tanzania  Mbeya Tanzania"},{"name":"Baylor College of Medicine Children's Foundation \u2013 Tanzania  Mwanza Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5,12]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"UNAIDS.Word AIDS Day. 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