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However, evidence on the clinical implications of LLV among adolescents living with HIV remains limited. This study aimed to assess the prevalence and predictors of LLV and to determine the association between LLV and subsequent virological failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed data from an integrated prospective cohort of adolescents living with HIV linked to the National Institute for Communicable Diseases (NICD) data warehouse in South Africa. Using routine viral load data from 2015 to 2021, we estimated the prevalence of LLV at the first test. We then used mixed\u2010effects logistic regression to identify socio\u2010demographic factors associated with LLV. Among adolescents with at least three viral load measurements, we assessed the association between LLV and subsequent virological failure using a Cox proportional hazards model in RStudio.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 730 adolescents, the prevalence of LLV ranged between 10.4% and 20.1%. Older adolescents aged 15\u201319\u2009years (aOR: 1.92; 95% CI: 1.44\u20132.55) and those \u226520\u2009years (aOR: 1.69; 95% CI: 1.12\u20132.57) had significantly higher odds of LLV compared to those 10\u201314\u2009years. Among 617 adolescents, 13.3% had LLV, of which 17.1% subsequently progressed to virological failure. Those experiencing LLV were associated with a four\u2010fold (aHR 4.91; 95% CI: 2.46\u20139.79) increased hazard of virological failure compared to suppressed adolescents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The prevalence of LLV among adolescents living with HIV on ART is high and LLV strongly predicts virological failure. Enhanced adherence support for adolescents with LLV is needed to minimize the risk of long\u2010term virological failure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hiv.70228","type":"journal-article","created":{"date-parts":[[2026,4,5]],"date-time":"2026-04-05T12:09:12Z","timestamp":1775390952000},"page":"1018-1030","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence of low\u2010level viremia and its association with virological failure among adolescents living with\n                    <scp>HIV<\/scp>\n                    in Eastern Cape, South Africa"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7255-3645","authenticated-orcid":false,"given":"Zea","family":"Leon","sequence":"first","affiliation":[{"name":"Centre for Social Science Research University of Cape Town  Cape Town South 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Evidence\u2010Based Intervention, Department of Social Policy and Intervention University of Oxford  Oxford UK"},{"name":"Department of Psychiatry and Mental Health University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gayle","family":"Sherman","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Faculty of Health Sciences University of the Witwatersrand  Johannesburg South Africa"},{"name":"Centre for HIV and STIs National Institute for Communicable Diseases, National Health Laboratory Service  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad H.","family":"Mazanderani","sequence":"additional","affiliation":[{"name":"Centre for HIV and STIs National Institute for Communicable Diseases, National Health Laboratory Service  Johannesburg South 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