{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,14]],"date-time":"2026-11-14T07:52:29Z","timestamp":1794642749925,"version":"4.9.1"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,11,3]],"date-time":"2020-11-03T00:00:00Z","timestamp":1604361600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,11,3]],"date-time":"2020-11-03T00:00:00Z","timestamp":1604361600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009054","name":"U.S. President\u2019s Emergency Plan for AIDS Relief","doi-asserted-by":"publisher","award":["U2G GH002099-01"],"award-info":[{"award-number":["U2G GH002099-01"]}],"id":[{"id":"10.13039\/100009054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009054","name":"U.S. President\u2019s Emergency Plan for AIDS Relief","doi-asserted-by":"publisher","award":["PA GH17-1753 (ACHIEVE)"],"award-info":[{"award-number":["PA GH17-1753 (ACHIEVE)"]}],"id":[{"id":"10.13039\/100009054","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Institute of Health","award":["NIH R01AI147331-01 (RAI147331A)"],"award-info":[{"award-number":["NIH R01AI147331-01 (RAI147331A)"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["AIDS Res Ther"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n<jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>A substantial number of persons living with HIV (PLWH) in Nigeria do not experience durable viral suppression on first-line antiretroviral therapy (ART). Understanding risk factors for first-line treatment failure informs patient monitoring practices and distribution of limited resources for second-line regimens. We determined predictors of immunologic and virologic failures in a large ART delivery program in Abuja, Nigeria.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>A retrospective cohort study was conducted at the University of Abuja Teaching Hospital, a tertiary health care facility, using data from February 2005 to December 2014 in Abuja, Nigeria. All PLWH aged \u2265\u200915\u00a0years who initiated ART with at least 6-month follow-up and one CD4 measurement were included. Immunologic failure was defined as a CD4 decrease to or below pre-ART level or persistent CD4 &lt;\u2009100 cells per mm<jats:sup>3<\/jats:sup> after 6\u00a0months on ART. Virologic failure (VF) was defined as two consecutive HIV-1 RNA levels &gt;\u20091000 copies\/mL after at least 6\u00a0months of ART and enhanced adherence counselling. HIV drug resistance (Sanger sequences) was analyzed using the Stanford HIV database algorithm and scored for resistance to common nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs). Univariate and multivariate log binomial regression models were used to estimate relative risks (RRs) and 95% confidence intervals (CIs).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Of 12,452 patients followed, a total of 5928 initiated ART with at least 6\u00a0months of follow-up and one CD4 measurement. The entry point for 3924 (66.2%) was through the program\u2019s own voluntary counseling and testing (VCT) center, while 1310 (22.1%) were referred from an outside clinic\/program, 332 (5.6%) in-patients, and 373 (6.3%) through other entry points including prevention of mother to child transmission (PMTCT) and transferred from other programs. The mean CD4 at enrollment in care was 268\u2009\u00b1\u200923.7 cells per mm<jats:sup>3<\/jats:sup>, and the mean HIV-1 RNA was 3.3\u2009\u00b1\u20091.3.log<jats:sub>10<\/jats:sub> copies\/mL. A total of 3468 (80.5%) received nevirapine (NVP) and 2260 (19.5%) received efavirenz (EFV)\u2014based regimens. A total of 2140 (36.1%) received tenofovir (TDF); 2662 (44.9%) zidovudine (AZT); and 1126 (19.0%) stavudine (d4T). Among those receiving TDF, 45.0% also received emtricitabine (FTC). In a multivariate model, immunologic failure was more common among PLWH with female gender as compared to male [RR (95% CI) 1.22 (1.07\u20131.40)] and less common among those who entered care at the program\u2019s VCT center as compared to other entry points [0.79 (0.64\u20130.91)], WHO stage 3\/4 as compared to 1\/2 [0.19 (0.16\u20130.22)], or CD4 200\u2009+\u2009cells per mm<jats:sup>3<\/jats:sup> as compared to lower [0.19 (0.16\u20130.22)]. Virologic failure was more common among PLWH who entered care at the program\u2019s VCT center as compared to other entry points [RR (95% CI) 1.45 (1.11\u20131.91) and those with CD4\u2009&lt;\u2009200 cells per mm<jats:sup>3<\/jats:sup> at entry into care as compared to higher [1.71 (1.36\u20132.16)]. Of 198 patient-derived samples sequenced during virologic failure, 42 (21%) were wild-type; 145 (73%) carried NNRTI drug resistance mutations; 151 (76.3%) M184I\/V; 29 (14.6%) had \u2265\u20093 TAMs, and 37 (18.7%) had K65R, of whom all were on TDF-containing first-line regimens.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>In this cohort of Nigerian PLWH followed for a period of 9\u00a0years, immunologic criteria poorly predicted virologic failure. Furthermore, a subset of samples showed that patients failing ART for extended periods of time had HIV-1 strains harboring drug resistance mutations.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12981-020-00317-9","type":"journal-article","created":{"date-parts":[[2020,11,3]],"date-time":"2020-11-03T13:03:13Z","timestamp":1604408593000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Predictors of first-line antiretroviral therapy failure among adults and adolescents living with HIV\/AIDS in a large prevention and treatment program in Nigeria"],"prefix":"10.1186","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9498-3428","authenticated-orcid":false,"given":"Nicaise","family":"Ndembi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fati","family":"Murtala-Ibrahim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monday","family":"Tola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jibreel","family":"Jumare","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Aliyu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Alabi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Mensah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alash\u2019le","family":"Abimiku","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel E.","family":"Qui\u00f1ones-Mateu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trevor A.","family":"Crowell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soo-Yon","family":"Rhee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert W.","family":"Shafer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravindra","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Blattner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manhattan E.","family":"Charurat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Dakum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,11,3]]},"reference":[{"key":"317_CR1","unstructured":"UNAIDS. 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