{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T14:36:32Z","timestamp":1776868592067,"version":"3.51.2"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite antiretroviral therapy (ART) scale-up in sub-Saharan Africa, treatment failure remains a significant challenge. We characterised virological and immunological outcomes among people living with HIV (PLHIV) attending tertiary care facilities in Nigeria, with exploratory analysis of potential mechanistic factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This multi-centre cross-sectional study enrolled 517 HIV-positive adults from four Nigerian tertiary facilities between January 2019 and December 2021. Primary outcomes included viral load suppression (&amp;lt;1,000 copies\/mL) and CD4 count. Exploratory mechanistic analyses examined drug resistance mutations (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f50), immune activation markers (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f40), and inflammatory biomarkers (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f35) in pilot subsets.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 412 participants with viral load data, only 111 (26.9%; 95% CI 22.7\u201331.5) achieved viral suppression, substantially below the UNAIDS 95% target. Of 387 with CD4 data, 149 (38.5%; 95% CI 33.6\u201343.6) had severe immunodeficiency (&amp;lt;200 cells\/\u03bcL). Among 346 participants with complete data, discordant responses were common: 25.7% showed virological failure with preserved immunity, while 6.6% had immunological failure despite viral suppression. In pilot mechanistic subsets, 86% of viraemic participants harboured drug resistance mutations, with M184V (62%) and K103N (54%) predominating. CD8 T-cell activation (CD38+HLA-DR+) was significantly elevated in viraemic versus suppressed participants (median 28.6% vs. 12.4%;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), correlating inversely with CD4 count (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u202f=\u202f\u22120.46;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>HIV treatment outcomes at Nigerian tertiary facilities fall substantially short of global targets. The high prevalence of discordant immune-virological responses and preliminary evidence of drug resistance and immune activation suggest multiple interacting pathways to treatment failure. Larger mechanistic studies are warranted to inform targeted interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1777588","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T04:42:55Z","timestamp":1775018575000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["HIV treatment failure in tertiary care: clinical epidemiology and preliminary mechanistic characterisation"],"prefix":"10.3389","volume":"14","author":[{"given":"Peter Mac","family":"Asaga","sequence":"first","affiliation":[{"name":"Institute for Infection Prevention and Control, Medical Center, Faculty of Medicine, University of Freiburg","place":["Freiburg, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Axel","family":"Kroeger","sequence":"additional","affiliation":[{"name":"Centre for Medicine and Society, Universitatklinikum Freiburg","place":["Freiburg, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunday","family":"Omilabu","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Lagos","place":["Lagos, Nigeria"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philomena E.","family":"Airiohuodion","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Lagos","place":["Lagos, Nigeria"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arthur","family":"Oragwa","sequence":"additional","affiliation":[{"name":"Faculty of Veterinary Medicine, University of Jos","place":["Jos, Nigeria"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah","family":"Buba","sequence":"additional","affiliation":[{"name":"Faculty of Veterinary Medicine, University of Jos","place":["Jos, Nigeria"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chukwuma","family":"Anyaike","sequence":"additional","affiliation":[{"name":"Federal Ministry of Health","place":["Abuja, Nigeria"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"ref1","volume-title":"The Path that Ends AIDS: 2023 UNAIDS Global AIDS Update","year":"2023"},{"key":"ref2","volume-title":"HIV and AIDS: Fact Sheet","year":"2024"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e2540","DOI":"10.1002\/rmv.2540","article-title":"Prevalence and factors associated with viral non-suppression in people living with HIV receiving antiretroviral therapy in sub-Saharan Africa: a systematic review and meta-analysis","volume":"34","author":"Mosha","year":"2024","journal-title":"Rev Med 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