{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T12:46:13Z","timestamp":1789562773977,"version":"build-2803163510"},"reference-count":26,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2022,5,20]],"date-time":"2022-05-20T00:00:00Z","timestamp":1653004800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"The President\u2019s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention","award":["GH001612-04"],"award-info":[{"award-number":["GH001612-04"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Antiviral Therapy"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>We assessed the prevalence of acquired HIV drug resistance (HIVDR) and associated factors among patients receiving first-line antiretroviral therapy (ART) in Rwanda.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study included 702 patients receiving first-line ART for at least 6\u00a0months with last viral load (VL) results \u22651000 copies\/mL. Blood plasma samples were subjected to VL testing; specimens with unsuppressed VL were genotyped to identify HIVDR-associated mutations. Data were analysed using STATA\/SE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Median time on ART was 86.4 months (interquartile range [IQR], 44.8\u2013130.2\u00a0months), and median CD4 count at ART initiation was 311 cells\/mm\n                      <jats:sup>3<\/jats:sup>\n                      (IQR, 197\u2013484 cells\/mm\n                      <jats:sup>3<\/jats:sup>\n                      ). Of 414 (68.2%) samples with unsuppressed VL, 378 (88.3%) were genotyped. HIVDR included 347 (90.4%) non-nucleoside reverse transcriptase inhibitor- (NNRTI), 291 (75.5%) nucleoside reverse transcriptase inhibitor- (NRTI) and 13 (3.5%) protease inhibitor (PI) resistance-associated mutations. The most common HIVDR mutations were K65R (22.7%), M184V (15.4%) and D67N (9.8%) for NRTIs and K103N (34.4%) and Y181C\/I\/V\/YC (7%) for NNRTIs. Independent predictors of acquired HIVDR included current ART regimen of zidovudine + lamivudine + nevirapine (adjusted odds ratio [aOR], 3.333 [95% confidence interval (CI): 1.022\u201310.870]; p = 0.046) for NRTI resistance and current ART regimen of tenofovir + emtricitabine + nevirapine (aOR, 0.148 [95% CI: 0.028\u20130.779]; p = 0.025), zidovudine + lamivudine + efavirenz (aOR, 0.105 [95% CI: 0.016\u20130.693]; p = 0.020) and zidovudine + lamivudine + nevirapine (aOR, 0.259 [95% CI: 0.084\u20130.793]; p = 0.019) for NNRTI resistance. History of ever switching ART regimen was associated with NRTI resistance (aOR, 2.53 [95% CI: 1.198\u20135.356]; p = 0.016) and NNRTI resistance (aOR, 3.23 [95% CI: 1.435\u20137.278], p = 0.005).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The prevalence of acquired HIV drug resistance (HIVDR) was high among patient failing to re-suppress VL and was associated with current ART regimen and ever switching ART regimen. The findings of this study support the current WHO guidelines recommending that patients on an NNRTI-based regimen should be switched based on a single viral load test and suggests that national HIV VL monitoring of patients receiving ART has prevented long-term treatment failure that would result in the accumulation of TAMs and potential loss of efficacy of all NRTI used in second-line ART as the backbone in combination with either dolutegravir or boosted PIs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13596535221102690","type":"journal-article","created":{"date-parts":[[2022,5,20]],"date-time":"2022-05-20T15:47:59Z","timestamp":1653061679000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":21,"title":["Acquired HIV drug resistance among adults living with HIV receiving first-line antiretroviral therapy in Rwanda: A cross-sectional nationally representative survey"],"prefix":"10.1177","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9552-3298","authenticated-orcid":false,"given":"Gentille","family":"Musengimana","sequence":"first","affiliation":[{"name":"Ministry of Health, Rwanda Biomedical Center, HIV\/AIDs, STIs and OBBI Division, Kigali City, Rwanda"},{"name":"U.S. Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV & TB, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elysee","family":"Tuyishime","sequence":"additional","affiliation":[{"name":"U.S. Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV & TB, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athanase","family":"Kiromera","sequence":"additional","affiliation":[{"name":"University of Maryland, Center for International Health, Education and Biosecurity, (CIHEB), Baltimore, MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel S.","family":"Malamba","sequence":"additional","affiliation":[{"name":"U.S. Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV & TB, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Augustin","family":"Mulindabigwi","sequence":"additional","affiliation":[{"name":"Ministry of Health, Rwanda Biomedical Center, HIV\/AIDs, STIs and OBBI Division, Kigali City, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madjid R.","family":"Habimana","sequence":"additional","affiliation":[{"name":"Ministry of Health, Rwanda Biomedical Center, HIV\/AIDs, STIs and OBBI Division, Kigali City, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyprien","family":"Baribwira","sequence":"additional","affiliation":[{"name":"University of Maryland, Center for International Health, Education and Biosecurity, (CIHEB), Baltimore, MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhayimpundu","family":"Ribakare","sequence":"additional","affiliation":[{"name":"Ministry of Health, Rwanda Biomedical Center, HIV\/AIDs, STIs and OBBI Division, Kigali City, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Savio D.","family":"Habimana","sequence":"additional","affiliation":[{"name":"Ministry of Health, Rwanda Biomedical Center, HIV\/AIDs, STIs and OBBI Division, Kigali City, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3306-1462","authenticated-orcid":false,"given":"Josh","family":"DeVos","sequence":"additional","affiliation":[{"name":"U.S. Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV & TB, Atlanta, GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard C. N.","family":"Mwesigwa","sequence":"additional","affiliation":[{"name":"U.S. Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV & TB, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugenie","family":"Kayirangwa","sequence":"additional","affiliation":[{"name":"U.S. Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV & TB, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jules M.","family":"Semuhore","sequence":"additional","affiliation":[{"name":"World Health Organization, Rwanda Office"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gallican N.","family":"Rwibasira","sequence":"additional","affiliation":[{"name":"Ministry of Health, Rwanda Biomedical Center, HIV\/AIDs, STIs and OBBI Division, Kigali City, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amitabh B.","family":"Suthar","sequence":"additional","affiliation":[{"name":"U.S. Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV & TB, Atlanta, GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Remera","sequence":"additional","affiliation":[{"name":"Ministry of Health, Rwanda Biomedical Center, HIV\/AIDs, STIs and OBBI Division, Kigali City, Rwanda"},{"name":"University of Basel, Basel, Switzerland"},{"name":"Swiss Tropical and Public Health Institute, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,5,20]]},"reference":[{"key":"bibr1-13596535221102690","volume-title":"Guideline on when to Start Antiretroviral Therapy and on Pre-exposure Prophylaxis for HIV","author":"World Health Organization","year":"2015"},{"key":"bibr2-13596535221102690","volume-title":"Guidance for Sampling Art Clinics in Countries Combining Surveillance of Pre-treatment HIV Drug Resistance and Acquired HIV Drug Resistance at 12 and 48+ Months","author":"World Health Organization","year":"2017"},{"key":"bibr3-13596535221102690","doi-asserted-by":"publisher","DOI":"10.1097\/COH.0b013e32835b7f94"},{"key":"bibr4-13596535221102690","volume-title":"Rwanda National HIV and Viral Hepatitis Annual Report 2017\u20132018","author":"Biomedical Center Rwanda","year":"2018"},{"key":"bibr5-13596535221102690","volume-title":"National Guidelines for Prevention and Management of HIV and STIs","author":"Rwanda Ministry of Health","year":"2016"},{"key":"bibr6-13596535221102690","doi-asserted-by":"publisher","DOI":"10.3851\/IMP2999"},{"key":"bibr7-13596535221102690","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.12717"},{"key":"bibr8-13596535221102690","doi-asserted-by":"publisher","DOI":"10.3851\/IMP3005"},{"key":"bibr9-13596535221102690","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0b013e31829e6b9f"},{"key":"bibr10-13596535221102690","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0064345"},{"key":"bibr11-13596535221102690","volume-title":"Surveillance of HIV Drug Resistance in Adults Receiving ART, (Aquired HIV Drug Resistance)","author":"World Health Organization","year":"2014"},{"key":"bibr12-13596535221102690","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0211326"},{"key":"bibr13-13596535221102690","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-018-3639-y"},{"key":"bibr14-13596535221102690","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/8909232"},{"key":"bibr15-13596535221102690","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(15)00536-8"},{"key":"bibr16-13596535221102690","volume-title":"Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture; Approved Standard-Fifth Edition","author":"Clinical Na Laboratry Standards Institute","year":"2007"},{"key":"bibr17-13596535221102690","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2101609"},{"key":"bibr18-13596535221102690","volume-title":"Consolidated Guidelines on HIV Prevention, Testing, Treatment, Service Delivery and Monitoring: Recommendations for a Public Health Approach","author":"The World Health Organization","year":"2021"},{"key":"bibr19-13596535221102690","doi-asserted-by":"publisher","DOI":"10.1186\/s12985-020-01311-3"},{"key":"bibr20-13596535221102690","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu314"},{"key":"bibr21-13596535221102690","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e3181bc478b"},{"key":"bibr22-13596535221102690","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2017.03.024"},{"key":"bibr23-13596535221102690","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis254"},{"key":"bibr24-13596535221102690","doi-asserted-by":"publisher","DOI":"10.1086\/587109"},{"key":"bibr25-13596535221102690","doi-asserted-by":"publisher","DOI":"10.1046\/j.1468-1293.2002.00101.x"},{"key":"bibr26-13596535221102690","volume-title":"HIV Drug Resistance Report 2021","author":"World Health Organization","year":"2021"}],"container-title":["Antiviral Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/13596535221102690","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/13596535221102690","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/13596535221102690","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T12:53:07Z","timestamp":1777380787000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/13596535221102690"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,20]]},"references-count":26,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2022,6]]}},"alternative-id":["10.1177\/13596535221102690"],"URL":"https:\/\/doi.org\/10.1177\/13596535221102690","relation":{},"ISSN":["1359-6535","2040-2058"],"issn-type":[{"value":"1359-6535","type":"print"},{"value":"2040-2058","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,20]]},"article-number":"13596535221102690"}}