{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T20:12:07Z","timestamp":1789503127872,"version":"build-2803163510"},"reference-count":58,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,10,27]],"date-time":"2021-10-27T00:00:00Z","timestamp":1635292800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,10,27]],"date-time":"2021-10-27T00:00:00Z","timestamp":1635292800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"ONG Carlos Rodolfo Mejia Villatoro"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["AIDS Res Ther"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>Viral suppression prevents HIV transmission and disease progression, but socio-economic and clinical factors can hinder the goal of suppression. We evaluated factors associated with viral non suppression (VNS) and persistent viremia (PV) in people living with HIV (PLHIV) receiving antiretroviral therapy (ART) in Guatemala.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We conducted a cross sectional analysis using data from an ongoing cohort of PLHIV attending the largest HIV clinic in Guatemala. Univariable and multivariable analyses were conducted between PLHIV with viral suppression and detectable viremia. VNS was defined as most recent HIV RNA\u2009\u2265\u2009200 copies\/ml and PV as two consecutive HIV RNA\u2009\u2265\u2009200 copies\/ml.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Of 664 participants, 13.3% had VNS and 7.1% had PV. In univariable analysis disaggregated by gender, low income, poor education, perceived difficulty attending healthcare, and alcohol use were associated with VNS in men while low CD4 at diagnosis, multiple prior ART regimens and treatment interruptions were significant in both genders. Multiple prior ART regimens (adjusted Odds Ratio (aOR) 2.82, [95% confidence interval (CI) 1.59, 4.99], <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01), treatment interruptions (aOR 4.51, [95% CI 2.13, 9.58], <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01), excessive alcohol consumption (aOR 2.56, [95% CI 1.18, 5.54], <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05) perceived difficulty attending healthcare (aOR 2.07, [ 95% CI 1.25, 3.42], <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) and low CD4 at diagnosis (aOR 2.34, 95% [CI 1.30, 4.20], <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) were independently associated with VNS on multivariable regression.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>We conclude that socio-economic and clinical factors influence viral suppression in our cohort and vary between men and women. Gender specific approaches are necessary to achieve the 90% suppression goal.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12981-021-00400-9","type":"journal-article","created":{"date-parts":[[2021,10,27]],"date-time":"2021-10-27T18:02:38Z","timestamp":1635357758000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Factors associated with viremia in people living with HIV on antiretroviral therapy in Guatemala"],"prefix":"10.1186","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6895-3826","authenticated-orcid":false,"given":"Dean W.","family":"Ort\u00edz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia","family":"Roberts-Sano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo E.","family":"Marroquin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey","family":"Larson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine B.","family":"Franco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrej","family":"Spec","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna R.","family":"Melendez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodolfo","family":"Pinz\u00f3n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana J.","family":"Samayoa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Mejia-Chew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane A.","family":"O\u00b4Halloran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,10,27]]},"reference":[{"key":"400_CR1","volume-title":"90\u201390\u201390: an ambitious treatment target to help end the AIDS epidemic","author":"UNAIDS","year":"2014","unstructured":"UNAIDS. 90\u201390\u201390: an ambitious treatment target to help end the AIDS epidemic. Geneva: UNAIDS; 2014."},{"key":"400_CR2","volume-title":"UNAIDS Data 2019","author":"UNAIDS","year":"2019","unstructured":"UNAIDS. UNAIDS Data 2019. Geneva: UNAIDS; 2019."},{"key":"400_CR3","volume-title":"Advancing towards 2020: progress in Latin America and the Caribbean","author":"UNAIDS","year":"2020","unstructured":"UNAIDS. Advancing towards 2020: progress in Latin America and the Caribbean. Geneva: UNAIDS; 2020."},{"issue":"1","key":"400_CR4","doi-asserted-by":"publisher","first-page":"e25066","DOI":"10.1002\/jia2.25066","volume":"21","author":"JM Costa","year":"2018","unstructured":"Costa JM, Torres TS, Coelho LE, Luz PM. Adherence to antiretroviral therapy for HIV\/AIDS in Latin America and the Caribbean: systematic review and meta-analysis. J Int AIDS Soc. 2018;21(1):e25066.","journal-title":"J Int AIDS Soc"},{"key":"400_CR5","unstructured":"CDC. HIV Treatment as prevention: center for disease control and prevention; 2020. [Updated 2020\u201304\u201306T05:07:42Z]. https:\/\/www.cdc.gov\/hiv\/risk\/art\/index.html. Accessed 12 Aug 2020."},{"issue":"10","key":"400_CR6","doi-asserted-by":"publisher","first-page":"673","DOI":"10.3109\/00365548.2014.926565","volume":"46","author":"J Albert","year":"2014","unstructured":"Albert J, Berglund T, Gissl\u00e9n M, et al. Risk of HIV transmission from patients on antiretroviral therapy: a position statement from the Public Health Agency of Sweden and the Swedish Reference Group for Antiviral Therapy. Scand J Infect Dis. 2014;46(10):673\u20137.","journal-title":"Scand J Infect Dis"},{"issue":"2","key":"400_CR7","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1001\/jama.2016.5148","volume":"316","author":"AJ Rodger","year":"2016","unstructured":"Rodger AJ, Cambiano V, Bruun T, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA. 2016;316(2):171\u201381.","journal-title":"JAMA"},{"issue":"8","key":"400_CR8","doi-asserted-by":"publisher","first-page":"e438","DOI":"10.1016\/S2352-3018(18)30132-2","volume":"5","author":"BR Bavinton","year":"2018","unstructured":"Bavinton BR, Pinto AN, Phanuphak N, et al. Viral suppression and HIV transmission in serodiscordant male couples: an international, prospective, observational, cohort study. Lancet HIV. 2018;5(8):e438\u201347.","journal-title":"Lancet HIV"},{"issue":"7","key":"400_CR9","doi-asserted-by":"publisher","first-page":"e0180761","DOI":"10.1371\/journal.pone.0180761","volume":"12","author":"O Elvstam","year":"2017","unstructured":"Elvstam O, Medstrand P, Yilmaz A, Isberg PE, Gissl\u00e9n M, Bj\u00f6rkman P. Virological failure and all-cause mortality in HIV-positive adults with low-level viremia during antiretroviral treatment. PLoS ONE. 2017;12(7):e0180761.","journal-title":"PLoS ONE"},{"issue":"3","key":"400_CR10","doi-asserted-by":"publisher","first-page":"e25088","DOI":"10.1002\/jia2.25088","volume":"21","author":"G Carriquiry","year":"2018","unstructured":"Carriquiry G, Giganti MJ, Castilho JL, et al. Virologic failure and mortality in older ART initiators in a multisite Latin American and Caribbean Cohort. J Int AIDS Soc. 2018;21(3):e25088.","journal-title":"J Int AIDS Soc"},{"issue":"15","key":"400_CR11","doi-asserted-by":"publisher","first-page":"e3361","DOI":"10.1097\/MD.0000000000003361","volume":"95","author":"WM Bezabhe","year":"2016","unstructured":"Bezabhe WM, Chalmers L, Bereznicki LR, Peterson GM. Adherence to antiretroviral therapy and virologic failure: a meta-analysis. Medicine. 2016;95(15):e3361.","journal-title":"Medicine"},{"key":"400_CR12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/09540121.2020.1757019","volume":"32","author":"JP Ridgway","year":"2020","unstructured":"Ridgway JP, Friedman EE, Choe J, Nguyen CT, Schuble T, Pettit NN. Impact of mail order pharmacy use and travel time to pharmacy on viral suppression among people living with HIV. AIDS Care. 2020;32:1\u20137.","journal-title":"AIDS Care"},{"issue":"4","key":"400_CR13","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1097\/QAI.0b013e3181648dfd","volume":"47","author":"R Joy","year":"2008","unstructured":"Joy R, Druyts EF, Brandson EK, et al. Impact of neighborhood-level socioeconomic status on HIV disease progression in a universal health care setting. JAIDS J Acquir Immune Defic Syndr. 2008;47(4):500\u20135.","journal-title":"JAIDS J Acquir Immune Defic Syndr"},{"key":"400_CR14","first-page":"8909232","volume":"2020","author":"G Diress","year":"2020","unstructured":"Diress G, Dagne S, Alemnew B, Adane S, Addisu A. Viral Load Suppression after enhanced adherence counseling and its predictors among high viral load HIV seropositive people in North Wollo Zone Public Hospitals, Northeast Ethiopia, 2019: retrospective cohort study. AIDS Res Treat. 2020;2020:8909232.","journal-title":"AIDS Res Treat"},{"issue":"4","key":"400_CR15","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1002\/phar.1728","volume":"36","author":"S Scott Sutton","year":"2016","unstructured":"Scott Sutton S, Magagnoli J, Hardin JW. Impact of pill burden on adherence, risk of hospitalization, and viral suppression in patients with HIV infection and AIDS receiving antiretroviral therapy. Pharmacother J Hum Pharmacol Drug Ther. 2016;36(4):385\u2013401.","journal-title":"Pharmacother J Hum Pharmacol Drug Ther"},{"issue":"5","key":"400_CR16","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1097\/00042560-200112150-00006","volume":"28","author":"A Ammassari","year":"2001","unstructured":"Ammassari A, Murri R, Pezzotti P, et al. Self-reported symptoms and medication side effects influence adherence to highly active antiretroviral therapy in persons with HIV infection. J Acquir Immune Defic Syndr. 2001;28(5):445\u20139.","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"2","key":"400_CR17","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","volume":"42","author":"PA Harris","year":"2009","unstructured":"Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)\u2014a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377\u201381.","journal-title":"J Biomed Inform"},{"key":"400_CR18","unstructured":"CDC. HIV among people aged 50 and over: CDC; 2020. [Updated 2020\u201306\u201304T05:30:43Z]. https:\/\/www.cdc.gov\/hiv\/group\/age\/olderamericans\/index.html. Accessed 15 Aug 2020."},{"issue":"4","key":"400_CR19","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1016\/0160-8002(81)90046-0","volume":"15","author":"S Annis","year":"1981","unstructured":"Annis S. Physical access and utilization of health services in rural Guatemala. Soc Sci Med Part D Med Geogr. 1981;15(4):515\u201323.","journal-title":"Soc Sci Med Part D Med Geogr"},{"key":"400_CR20","volume-title":"Canasta B\u00e1sica Alimentaria (CBA) y Canasta Ampliada (CA) Enero 2020","author":"INE","year":"2020","unstructured":"INE. Canasta B\u00e1sica Alimentaria (CBA) y Canasta Ampliada (CA) Enero 2020. Geneva: Instituto Nacional de Estad\u00edstica Guatemala; 2020."},{"key":"400_CR21","unstructured":"CDC. Preventing excessive alcohol use [Updated 2020\u201304\u201308T02:04:20Z]. https:\/\/www.cdc.gov\/alcohol\/fact-sheets\/prevention.htm. Accessed 03 Sept 2020."},{"key":"400_CR22","first-page":"1","volume":"63","author":"R Selik","year":"2014","unstructured":"Selik R, Mokotoff E, Branson B, Owen M, Whitmore S, Hall H. Revised Surveillance Case Definition for HIV Infection - United States, 2014. MMWR Recomm Rep Morbidity Mortality Weekly Rep Recomm Rep Centers Dis Control. 2014;63:1\u201310.","journal-title":"MMWR Recomm Rep Morbidity Mortality Weekly Rep Recomm Rep Centers Dis Control"},{"issue":"1","key":"400_CR23","first-page":"55","volume":"27","author":"BC Mpondo","year":"2015","unstructured":"Mpondo BC, Kilonzo SB, Meda JR, Gunda DW. Prevalence and predictors of immunological failure among HIV-infected adults on HAART in Northwestern Tanzania: a cross sectional study. Tanzania Med J. 2015;27(1):55\u201369.","journal-title":"Tanzania Med J"},{"issue":"5","key":"400_CR24","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1093\/cid\/ciy989","volume":"69","author":"A Esber","year":"2018","unstructured":"Esber A, Polyak C, Kiweewa F, et al. Persistent low-level viremia predicts subsequent virologic failure: is it time to change the third 90? Clin Infect Dis. 2018;69(5):805\u201312.","journal-title":"Clin Infect Dis"},{"issue":"11","key":"400_CR25","doi-asserted-by":"publisher","first-page":"e0142923","DOI":"10.1371\/journal.pone.0142923","volume":"10","author":"G Leierer","year":"2015","unstructured":"Leierer G, Grabmeier-Pfistershammer K, Steuer A, Geit M, Sarcletti M, Haas B, et al. Factors associated with low-level viraemia and virological failure: results from the Austrian HIV cohort study. PLoS ONE. 2015;10(11):e0142923.","journal-title":"PLoS ONE"},{"issue":"1","key":"400_CR26","doi-asserted-by":"publisher","first-page":"50","DOI":"10.3390\/ijerph13010050","volume":"13","author":"G Maldonado-Mart\u00ednez","year":"2015","unstructured":"Maldonado-Mart\u00ednez G, Hunter-Mellado RF, Fern\u00e1ndez-Santos D, R\u00edos-Olivares E. Persistent HIV viremia: description of a cohort of HIV infected individuals with ART failure in Puerto Rico. Int J Environ Res Public Health. 2015;13(1):50.","journal-title":"Int J Environ Res Public Health"},{"issue":"10","key":"400_CR27","doi-asserted-by":"publisher","first-page":"e0219415","DOI":"10.1371\/journal.pone.0219415","volume":"14","author":"P Atuhaire","year":"2019","unstructured":"Atuhaire P, Hanley S, Yende-Zuma N, et al. Factors associated with unsuppressed viremia in women living with HIV on lifelong ART in the multi-country US-PEPFAR PROMOTE study: a cross-sectional analysis. PLoS ONE. 2019;14(10):e0219415.","journal-title":"PLoS ONE"},{"key":"400_CR28","unstructured":"Sinai IB, C. Cantelmo, R. Mbuya-Brown, Y. Panjshiri, and M. Balampama. Adolescent HIV in Tanzania: factors affecting viral load suppression and the transition to adult care. Washington, DC: Palladium, Health policy plus; 2020. http:\/\/www.healthpolicyplus.com\/ns\/pubs\/13334-13611_TanzaniaPediatricHIVReport.pdf. Accessed 10 Dec 2020."},{"issue":"10","key":"400_CR29","doi-asserted-by":"publisher","first-page":"1489","DOI":"10.1093\/cid\/cit529","volume":"57","author":"C Laprise","year":"2013","unstructured":"Laprise C, de Pokomandy A, Baril J-G, Dufresne S, Trottier H. Virologic failure following persistent low-level viremia in a cohort of HIV-positive patients: results from 12 years of observation. Clin Infect Dis. 2013;57(10):1489\u201396.","journal-title":"Clin Infect Dis"},{"issue":"8","key":"400_CR30","doi-asserted-by":"publisher","first-page":"e0161553","DOI":"10.1371\/journal.pone.0161553","volume":"11","author":"B Yakob","year":"2016","unstructured":"Yakob B, Ncama BP. Correlates of strengthening lessons from HIV\/AIDS treatment and care services in Ethiopia perceived access and implications for health system. PLoS ONE. 2016;11(8):e0161553.","journal-title":"PLoS ONE"},{"issue":"2","key":"400_CR31","doi-asserted-by":"publisher","first-page":"e25228","DOI":"10.1002\/jia2.25228","volume":"22","author":"MY Ahn","year":"2019","unstructured":"Ahn MY, Jiamsakul A, Khusuwan S, et al. The influence of age-associated comorbidities on responses to combination antiretroviral therapy in older people living with HIV. J Int AIDS Soc. 2019;22(2):e25228.","journal-title":"J Int AIDS Soc"},{"key":"400_CR32","doi-asserted-by":"publisher","first-page":"S214-S","DOI":"10.1093\/ofid\/ofy210.589","volume":"5","author":"H Jimenez","year":"2018","unstructured":"Jimenez H, Stevens T, Suh J. 581. Do comorbidities and polypharmacy lead to virologic failure in all populations living with HIV? Open Forum Infect Dis. 2018;5:S214-S.","journal-title":"Open Forum Infect Dis"},{"issue":"1","key":"400_CR33","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1089\/apc.2012.0329","volume":"27","author":"AT Rodriguez-Penney","year":"2013","unstructured":"Rodriguez-Penney AT, Iudicello JE, Riggs PK, et al. Co-morbidities in persons infected with HIV: increased burden with older age and negative effects on health-related quality of life. AIDS Patient Care STDS. 2013;27(1):5\u201316.","journal-title":"AIDS Patient Care STDS"},{"issue":"3","key":"400_CR34","doi-asserted-by":"publisher","first-page":"e012546","DOI":"10.1136\/bmjopen-2016-012546","volume":"7","author":"J Browne","year":"2017","unstructured":"Browne J, Edwards DA, Rhodes KM, Brimicombe DJ, Payne RA. Association of comorbidity and health service usage among patients with dementia in the UK: a population-based study. BMJ Open. 2017;7(3):e012546.","journal-title":"BMJ Open"},{"key":"400_CR35","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1186\/1471-2296-15-61","volume":"15","author":"S van Oostrom","year":"2014","unstructured":"van Oostrom S, Picavet S, de Bruin S, et al. Multimorbidity of chronic diseases and health care utilization in general practice. BMC Fam Pract. 2014;15:61.","journal-title":"BMC Fam Pract"},{"key":"400_CR36","unstructured":"Kassaye SG, Wang C, Ocampo JMF, et al. Viremia trajectories of HIV in HIV-positive women in the United States, 1994\u20132017. (2574\u20133805 (Electronic))."},{"issue":"7","key":"400_CR37","doi-asserted-by":"publisher","first-page":"976","DOI":"10.1093\/cid\/ciw418","volume":"63","author":"N Crepaz","year":"2016","unstructured":"Crepaz N, Tang T, Marks G, Mugavero MJ, Espinoza L, Hall HI. Durable viral suppression and transmission risk potential among persons with diagnosed HIV infection: United States, 2012\u20132013. Clin Infect Dis. 2016;63(7):976\u201383.","journal-title":"Clin Infect Dis"},{"issue":"5","key":"400_CR38","doi-asserted-by":"publisher","first-page":"e0154318","DOI":"10.1371\/journal.pone.0154318","volume":"11","author":"P Cherutich","year":"2016","unstructured":"Cherutich P, Kim AA, Kellogg TA, et al. Detectable HIV viral load in Kenya: data from a population-based survey. PLoS ONE. 2016;11(5):e0154318.","journal-title":"PLoS ONE"},{"issue":"2","key":"400_CR39","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1016\/S2055-6640(20)30466-0","volume":"2","author":"S Rangarajan","year":"2016","unstructured":"Rangarajan S, Donn JC, le Giang T, et al. Factors associated with HIV viral load suppression on antiretroviral therapy in Vietnam. J Virus Erad. 2016;2(2):94\u2013101.","journal-title":"J Virus Erad"},{"issue":"5","key":"400_CR40","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1111\/tmi.13373","volume":"25","author":"A Kroidl","year":"2020","unstructured":"Kroidl A, Burger T, Urio A, et al. High turnaround times and low viral resuppression rates after reinforced adherence counselling following a confirmed virological failure diagnostic algorithm in HIV-infected patients on first-line antiretroviral therapy from Tanzania. Trop Med Int Health. 2020;25(5):579\u201389.","journal-title":"Trop Med Int Health"},{"key":"400_CR41","volume-title":"ENEI 1\u20132019 Encuesta Nacional de Empleo e Ingresos","author":"N Guerra Morales","year":"2017","unstructured":"Guerra Morales N, Gomez Gomez F, Mancia Chua C. ENEI 1\u20132019 Encuesta Nacional de Empleo e Ingresos. Guatemala: Instituto Nacional de Estad\u00edstica de Guatemala; 2017."},{"issue":"6","key":"400_CR42","doi-asserted-by":"publisher","first-page":"e0158535","DOI":"10.1371\/journal.pone.0158535","volume":"11","author":"ML Ikeda","year":"2016","unstructured":"Ikeda ML, Barcellos NT, Alencastro PR, et al. Alcohol drinking pattern: a comparison between HIV-infected patients and individuals from the general population. PLoS ONE. 2016;11(6):e0158535.","journal-title":"PLoS ONE"},{"issue":"3","key":"400_CR43","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1111\/acer.12975","volume":"40","author":"RG Deiss","year":"2016","unstructured":"Deiss RG, Mesner O, Agan BK, et al. Characterizing the association between alcohol and hiv virologic failure in a military cohort on antiretroviral therapy. Alcohol Clin Exp Res. 2016;40(3):529\u201335.","journal-title":"Alcohol Clin Exp Res"},{"issue":"4","key":"400_CR44","doi-asserted-by":"publisher","first-page":"834","DOI":"10.1177\/1557988315605894","volume":"11","author":"TA Washington","year":"2017","unstructured":"Washington TA, Patel SN, Meyer-Adams N. Drinking patterns and HIV risk behaviors among black and latino men who have sex within Los Angeles County. Am J Mens Health. 2017;11(4):834\u201344.","journal-title":"Am J Mens Health"},{"key":"400_CR45","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6446a2","volume-title":"Lower levels of antiretroviral therapy enrollment among men with HIV compared with women\u201412 countries, 2002\u20132013","author":"AF Auld","year":"2015","unstructured":"Auld AF, Shiraishi RW, Mbofana FR, Couto A, Fetogang EB, El-Halabi S. Lower levels of antiretroviral therapy enrollment among men with HIV compared with women\u201412 countries, 2002\u20132013. Atlanta: Center for Disease Control; 2015."},{"issue":"suppl_2","key":"400_CR46","doi-asserted-by":"publisher","first-page":"S118","DOI":"10.1093\/cid\/cix1140","volume":"66","author":"M Osler","year":"2018","unstructured":"Osler M, Hilderbrand K, Goemaere E, et al. The continuing burden of advanced HIV disease over 10 years of increasing antiretroviral therapy coverage in South Africa. Clin Infect Dis. 2018;66(suppl_2):S118\u201325.","journal-title":"Clin Infect Dis"},{"issue":"2","key":"400_CR47","doi-asserted-by":"publisher","first-page":"e0211344","DOI":"10.1371\/journal.pone.0211344","volume":"14","author":"F Kiweewa","year":"2019","unstructured":"Kiweewa F, Esber A, Musingye E, et al. HIV virologic failure and its predictors among HIV-infected adults on antiretroviral therapy in the African Cohort Study. PLoS ONE. 2019;14(2):e0211344.","journal-title":"PLoS ONE"},{"issue":"13","key":"400_CR48","doi-asserted-by":"publisher","first-page":"2005","DOI":"10.1097\/QAD.0000000000002306","volume":"33","author":"J Fleming","year":"2019","unstructured":"Fleming J, Mathews WC, Rutstein RM, et al. Low-level viremia and virologic failure in persons with HIV infection treated with antiretroviral therapy. AIDS. 2019;33(13):2005\u201312.","journal-title":"AIDS"},{"issue":"4","key":"400_CR49","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1179\/1528433614Z.0000000019","volume":"16","author":"K Buchacz","year":"2015","unstructured":"Buchacz K, Wiegand R, Armon C, et al. Long-term immunologic and virologic responses on raltegravir-containing regimens among ART-experienced participants in the HIV Outpatient Study. HIV Clin Trials. 2015;16(4):139\u201346.","journal-title":"HIV Clin Trials"},{"key":"400_CR50","first-page":"88","volume-title":"Gu\u00eda de tratamiento antirretroviral y de infecciones oportunistas en Guatemala 2013","author":"Programa Nacional de Prevenci\u00f3n y Control de ITS, VIH y SIDA","year":"2013","unstructured":"Programa Nacional de Prevenci\u00f3n y Control de ITS, VIH y SIDA. Gu\u00eda de tratamiento antirretroviral y de infecciones oportunistas en Guatemala 2013. Ciudad de Guatemala: Ministerio de Salud P\u00fablica y Asistencia Social; 2013. p. 88."},{"key":"400_CR51","unstructured":"Programa Nacional de Prevenci\u00f3n y Control de ITS, VIH y SIDA. Gu\u00eda de uso de los antirretrovirales y en personas con VIH y su aplicaci\u00f3n profil\u00e1ctica 2019. Ciudad de Guatemala: Ministerio de Salud P\u00fablica y Asistencia Social; 2019. p. 73. https:\/\/www.mspas.gob.gt\/component\/jdownloads\/send\/410-guias\/2765-guia-de-uso-de-los-antirretrovirales-en-personas-con-vih-y-su-aplicacio-n-profila-ctica.html."},{"issue":"12","key":"400_CR52","doi-asserted-by":"publisher","first-page":"2145","DOI":"10.1093\/cid\/ciz129","volume":"69","author":"C Joya","year":"2019","unstructured":"Joya C, Won SH, Schofield C, et al. Persistent Low-level viremia while on antiretroviral therapy is an independent risk factor for virologic failure. Clin Infect Dis. 2019;69(12):2145\u201352.","journal-title":"Clin Infect Dis"},{"issue":"2","key":"400_CR53","doi-asserted-by":"publisher","first-page":"e1003037","DOI":"10.1371\/journal.pmed.1003037","volume":"17","author":"LE Hermans","year":"2020","unstructured":"Hermans LE, Carmona S, Nijhuis M, et al. Virological suppression and clinical management in response to viremia in South African HIV treatment program: a multicenter cohort study. PLoS Med. 2020;17(2):e1003037.","journal-title":"PLoS Med"},{"issue":"1","key":"400_CR54","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1186\/s12879-020-4837-y","volume":"20","author":"T Zhang","year":"2020","unstructured":"Zhang T, Ding H, An M, et al. Factors associated with high-risk low-level viremia leading to virologic failure: 16-year retrospective study of a Chinese antiretroviral therapy cohort. BMC Infect Dis. 2020;20(1):147.","journal-title":"BMC Infect Dis"},{"issue":"1","key":"400_CR55","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/s12981-018-0214-y","volume":"16","author":"D Bukenya","year":"2019","unstructured":"Bukenya D, Mayanja BN, Nakamanya S, Muhumuza R, Seeley J. What causes non-adherence among some individuals on long term antiretroviral therapy? Experiences of individuals with poor viral suppression in Uganda. AIDS Res Ther. 2019;16(1):2.","journal-title":"AIDS Res Ther"},{"issue":"1","key":"400_CR56","doi-asserted-by":"publisher","first-page":"3133","DOI":"10.1038\/s41598-018-21081-x","volume":"8","author":"J Kim","year":"2018","unstructured":"Kim J, Lee E, Park B-J, Bang JH, Lee JY. Adherence to antiretroviral therapy and factors affecting low medication adherence among incident HIV-infected individuals during 2009\u20132016: a nationwide study. Sci Rep. 2018;8(1):3133.","journal-title":"Sci Rep"},{"issue":"9","key":"400_CR57","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1371\/journal.pone.0203916","volume":"13","author":"Y Mendoza","year":"2018","unstructured":"Mendoza Y, Garc\u00eda-Morales C, Bello G, Garrido-Rodr\u00edguez D, Tapia-Trejo D, Pascale J. Evolutionary history and spatiotemporal dynamics of the HIV-1 subtype B epidemic in Guatemala. PLoS ONE. 2018;13(9):21.","journal-title":"PLoS ONE"},{"key":"400_CR58","doi-asserted-by":"publisher","DOI":"10.6084\/M9.FIGSHARE.13218806","author":"D Ortiz","year":"2020","unstructured":"Ortiz D, Roberts-Sano O, O\u2019Halloran J. Predictors of Viremia in PLWH in Guatemala_July 2019 to February 2020.sav. Figshare. 2020. https:\/\/doi.org\/10.6084\/M9.FIGSHARE.13218806."}],"container-title":["AIDS Research and Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12981-021-00400-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12981-021-00400-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12981-021-00400-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,27]],"date-time":"2021-10-27T19:02:37Z","timestamp":1635361357000},"score":1,"resource":{"primary":{"URL":"https:\/\/aidsrestherapy.biomedcentral.com\/articles\/10.1186\/s12981-021-00400-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,27]]},"references-count":58,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["400"],"URL":"https:\/\/doi.org\/10.1186\/s12981-021-00400-9","relation":{"references":[{"id-type":"uri","id":"","asserted-by":"subject"}]},"ISSN":["1742-6405"],"issn-type":[{"value":"1742-6405","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,27]]},"assertion":[{"value":"15 February 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 October 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 October 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Study design and methodology was approved by the Human Research Protection Office at Washington University in St. Louis(May 15, 2019\/IRB ID#201905033) and the local Ethics committee at Hospital Roosevelt in Guatemala (February 12, 2019\/Form 609, Point 5) in accordance to the International Ethical Guidelines for Health-related Research Involving Humans. A waiver of written consent was granted by the local ethics committee, and informed verbal consent was obtained for all individual participants included in the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethic approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors have no financial or proprietary interest in any material discussed in this article.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"79"}}