{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:54:03Z","timestamp":1791222843787,"version":"4.1.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"11","funder":[{"name":"Ministry of Foreign Affairs of the Netherlands"},{"name":"Stichting AidsFonds","award":["12454"],"award-info":[{"award-number":["12454"]}]},{"DOI":"10.13039\/501100014724","name":"Heineken Africa Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100014724","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Netherlands Organization for Scientific Research","award":["W 07.10.101"],"award-info":[{"award-number":["W 07.10.101"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Background. \u2003After the scale-up of antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection in Africa, increasing numbers of patients have pretreatment drug resistance.<\/jats:p>\n               <jats:p>Methods. \u2003In a large multicountry cohort of patients starting standard first-line ART in six African countries, pol genotyping was retrospectively performed if viral load (VL) \u22651000 cps\/mL. Pretreatment drug resistance was defined as a decreased susceptibility to \u22651 prescribed drug. We assessed the effect of pretreatment drug resistance on all-cause mortality, new AIDS events and switch to second-line ART due to presumed treatment failure, using Cox models.<\/jats:p>\n               <jats:p>Results. \u2003Among 2579 participants for whom a pretreatment genotype was available, 5.5% had pretreatment drug resistance. Pretreatment drug resistance was associated with an increased risk of regimen switch (adjusted hazard ratio [aHR] 3.80; 95% confidence interval [CI], 1.49\u20139.68; P = .005) but was not associated with mortality (aHR 0.75, 95% CI, .24\u20132.35; P = .617) or new AIDS events (aHR 1.06, 95% CI, .68\u20131.64; P = .807). During three years of follow up, 106 (4.1%) participants switched to second-line, of whom 18 (17.0%) switched with VL &amp;lt; 1000 cps\/mL, 7 (6.6%) with VL \u2265 1000 cps\/mL and no drug resistance mutations (DRMs), 46 (43.4%) with VL \u2265 1000 cps\/mL and \u22651 DRMs; no HIV RNA data was available for 32 (30.2%) participants.<\/jats:p>\n               <jats:p>Conclusions. \u2003Given rising pretreatment HIV drug resistance levels in sub-Saharan Africa, these findings underscore the need for expanded access to second-line ART. VL monitoring can improve the accuracy of failure detection and efficiency of switching practices.<\/jats:p>","DOI":"10.1093\/cid\/civ656","type":"journal-article","created":{"date-parts":[[2015,8,4]],"date-time":"2015-08-04T00:29:52Z","timestamp":1438648192000},"page":"1749-1758","source":"Crossref","is-referenced-by-count":38,"title":["Pretreatment HIV Drug Resistance Increases Regimen Switches in Sub-Saharan Africa"],"prefix":"10.1093","volume":"61","author":[{"given":"T. Sonia","family":"Boender","sequence":"first","affiliation":[{"name":"Amsterdam Institute for Global Health and Development and Department of Global Health 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernice M.","family":"Hoenderboom","sequence":"additional","affiliation":[{"name":"Amsterdam Institute for Global Health and Development and Department of Global Health 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim C. E.","family":"Sigaloff","sequence":"additional","affiliation":[{"name":"Amsterdam Institute for Global Health and Development and Department of Global Health 1"},{"name":"Academic Medical Center of the University of Amsterdam 2 Department of Internal Medicine, Division of Infectious Diseases , ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raph L.","family":"Hamers","sequence":"additional","affiliation":[{"name":"Amsterdam Institute for Global Health and Development and Department of Global Health 1"},{"name":"Academic Medical Center of the University of Amsterdam 2 Department of Internal Medicine, Division of Infectious Diseases , ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen","family":"Wellington","sequence":"additional","affiliation":[{"name":"Newlands Clinic 3 , Harare ,","place":["Zimbabwe"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tinei","family":"Shamu","sequence":"additional","affiliation":[{"name":"Newlands Clinic 3 , Harare ,","place":["Zimbabwe"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Siwale","sequence":"additional","affiliation":[{"name":"Lusaka Trust Hospital 4"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eman E. 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Hospital 7 Department of Haematology and Blood Transfusion , ,","place":["Nigeria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kishor","family":"Mandaliya","sequence":"additional","affiliation":[{"name":"Coast Province General Hospital 8 , Mombasa ,","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariette E.","family":"Botes","sequence":"additional","affiliation":[{"name":"Muelmed Hospital 9 , Pretoria ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascale","family":"Ondoa","sequence":"additional","affiliation":[{"name":"Amsterdam Institute for Global Health and Development and Department of Global Health 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias F.","family":"Rinke de Wit","sequence":"additional","affiliation":[{"name":"Amsterdam Institute for Global Health and Development and Department of Global Health 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