{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T08:56:09Z","timestamp":1777452969710,"version":"3.51.4"},"reference-count":32,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2018,5,1]],"date-time":"2018-05-01T00:00:00Z","timestamp":1525132800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Antiviral Therapy"],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>HIV viral load (VL) and resistance testing are limited in sub-Saharan Africa, so individuals may have prolonged time on failing first-line antiretroviral therapy (ART). Our objective was to describe the evolution of drug resistance mutations among adults failing first-line ART in Zambia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed data from a trial of VL monitoring in Lusaka, Zambia. From 2006 to 2011, 12 randomized sites provided either routine VL monitoring (intervention) or discretionary (control) after ART initiation. Samples were collected prospectively following the same schedule in each arm but analysed retrospectively in the control group. For those with virological failure (VF; &gt;400 copies\/ml), HIV genotyping was performed retrospectively on baseline (BL) and on all subsequent specimens until censored due to study completion, withdrawal or death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 1,973 enrollees, 165 (8.4%) developed VF. 464 genotype results were available including 132 (80%) at BL, 116 (70%) at VF and 125 (76%) had at least one result between VF and censoring. Major nucleoside reverse transcriptase inhibitor (NRTI) or non-nucleoside reverse transcriptase inhibitor (NNRTI) mutations increased from 26% (BL) to 82% (VF) to 89% at last genotype (LG). M184 mutations increased from 2% to 59% to 71%; K65R from 2% to 11% to 13%; 2 or more thymidine analogue mutations from 1% to 3% to 12%. Among those on a failing tenofovir disoproxil fumarate (TDF)-based regimen, TDF resistance increased from 42% to 58%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We found substantial resistance to NRTIs and NNRTIs at VF with incremental increases after VF while still on a failing first-line ART; this resistance may compromise attainment of the UNAIDS 90-90-90 goals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3851\/imp3299","type":"journal-article","created":{"date-parts":[[2019,4,12]],"date-time":"2019-04-12T06:50:48Z","timestamp":1555051848000},"page":"291-300","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Evolution of HIV-1 Drug Resistance after Virological Failure of First-line Antiretroviral Therapy in Lusaka, Zambia"],"prefix":"10.1177","volume":"24","author":[{"given":"F Parker","family":"Hudson","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University of Texas at Austin, Austin, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lloyd","family":"Mulenga","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Zambia, Lusaka, Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew O","family":"Westfall","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ranjit","family":"Warrier","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Research in Zambia, Lusaka, Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aggrey","family":"Mweemba","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Zambia, Lusaka, Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael S","family":"Saag","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey SA","family":"Stringer","sequence":"additional","affiliation":[{"name":"UNC Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph J","family":"Eron","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin H","family":"Chi","sequence":"additional","affiliation":[{"name":"UNC Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2018,5,1]]},"reference":[{"key":"bibr1-IMP3299","unstructured":"Global action plan on HIV drug resistance 2017-2021. Geneva: World Health Organization; 2017. (Accessed 10 January 2018.) Available from https:\/\/www.who.int\/hiv\/pub\/drugresistance\/hivdr-action-plan-2017-2021\/en\/"},{"key":"bibr2-IMP3299","unstructured":"Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach - 2nd ed. Geneva: World Health Organization; 2016. (Accessed 10 January 2018.) Available from https:\/\/www.who.int\/hiv\/pub\/arv\/arv-2016\/en\/"},{"key":"bibr3-IMP3299","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jix089"},{"key":"bibr4-IMP3299","unstructured":"HIV drug resistance report 2017. Geneva: World Health Organization; 2017. (Accessed 10 January 2018.) Available from https:\/\/www.who.int\/hiv\/pub\/drugresistance\/hivdr-report-2017\/en\/"},{"key":"bibr5-IMP3299","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis254"},{"key":"bibr6-IMP3299","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkw218"},{"key":"bibr7-IMP3299","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(15)00536-8"},{"key":"bibr8-IMP3299","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-12-381"},{"key":"bibr9-IMP3299","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000001285"},{"key":"bibr10-IMP3299","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0009680"},{"key":"bibr11-IMP3299","unstructured":"Saag M.S., Westfall A., Luhanga D.K. A cluster-randomized trial of routine vs. discretionary viral load monitoring among adults starting ART: Zambia.\n                      19th Conference on Retroviruses and Opportunistic Infections.\n                      5\u20138 March 2012, Seattle, WA, USA. Abstract 87"},{"key":"bibr12-IMP3299","doi-asserted-by":"publisher","DOI":"10.1089\/aid.2008.0035"},{"key":"bibr13-IMP3299","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.24162"},{"key":"bibr14-IMP3299","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jit114"},{"key":"bibr15-IMP3299","unstructured":"90-90-90 An ambitious treatment target to help end the AIDS epidemic. Geneva: Joint United Nations Programme on HIV\/AIDS (UNAIDS); 2014. (Accessed 10 January 2018.) Available from https:\/\/www.unaids.org\/en\/resources\/documents\/2017\/90-90-90"},{"key":"bibr16-IMP3299","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.12717"},{"key":"bibr17-IMP3299","unstructured":"Derache A., Iwuji C., Danaviah S. Prevalence and impact of pretreatment drug resistance in the ANRS 12249 TASP Trial.\n                      Conference on Retroviruses and Opportunistic Infections.\n                      13\u201316 February 2017, Seattle, WA, USA. Abstract 43"},{"key":"bibr18-IMP3299","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32830efd79"},{"key":"bibr19-IMP3299","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(11)70149-9"},{"key":"bibr20-IMP3299","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dym104"},{"key":"bibr21-IMP3299","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6446a3"},{"key":"bibr22-IMP3299","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000003985"},{"key":"bibr23-IMP3299","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.20.1.21371"},{"key":"bibr24-IMP3299","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(16)30469-8"},{"key":"bibr25-IMP3299","doi-asserted-by":"publisher","DOI":"10.3851\/IMP2010"},{"key":"bibr26-IMP3299","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-017-2709-x"},{"key":"bibr27-IMP3299","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix1108"},{"key":"bibr28-IMP3299","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1311274"},{"key":"bibr29-IMP3299","doi-asserted-by":"crossref","first-page":"2091","DOI":"10.1016\/S0140-6736(13)61164-2","volume":"381","author":"Boyd M.A.","year":"2013","journal-title":"Lancet"},{"key":"bibr30-IMP3299","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(16)30011-X"},{"key":"bibr31-IMP3299","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.37.7.2291-2296.1999"},{"key":"bibr32-IMP3299","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiv383"}],"container-title":["Antiviral Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.3851\/IMP3299","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.3851\/IMP3299","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.3851\/IMP3299","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T12:52:43Z","timestamp":1777380763000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.3851\/IMP3299"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,5,1]]},"references-count":32,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2019,5]]}},"alternative-id":["10.3851\/IMP3299"],"URL":"https:\/\/doi.org\/10.3851\/imp3299","relation":{},"ISSN":["1359-6535","2040-2058"],"issn-type":[{"value":"1359-6535","type":"print"},{"value":"2040-2058","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,5,1]]}}}