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To evaluate the impact of its incorporation into the World Health Organization (WHO) guidelines, we examined treatment failure and drug resistance among a cohort of patients on tenofovir\u2010based first\u2010line ART at the Academic Model Providing Access to Healthcare, a large HIV treatment programme in western Kenya.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We determined viral load (VL), drug resistance and their correlates in patients on \u2265six months of tenofovir\u2010based first\u2010line ART. Based on enrolled patients\u2019 characteristics, we described these measures in those with (prior ART group) and without (tenofovir\u2010only group) prior non\u2010tenofovir\u2010based first\u2010line ART using Wilcoxon rank sum and Fisher's exact tests.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 333 participants (55% female; median age 41 years; median CD4 336 cells\/\u00b5L), detectable (&gt;40 copies\/mL) VL was found in 18%, and VL&gt;1000 copies\/mL (WHO threshold) in 10%. Virologic failure at both thresholds was significantly higher in 217 participants in the tenofovir\u2010only group compared with 116 in the prior ART group using both cut\u2010offs (24% vs. 7% with VL&gt;40 copies\/mL; 15% vs. 1% with VL&gt;1000 copies\/mL). Failure in the tenofovir\u2010only group was associated with lower CD4 values and advanced WHO stage. In 35 available genotypes from 51 participants in the tenofovir\u2010only group with VL&gt;40 copies\/mL (69% subtype A), any resistance was found in 89% and dual\u2010class resistance in 83%. Tenofovir signature mutation K65R occurred in 71% (17\/24) of the patients infected with subtype A. Patients with K65R had significantly lower CD4 values, higher WHO stage and more resistance mutations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In this Kenyan cohort, tenofovir\u2010based first\u2010line ART resulted in good (90%) virologic suppression including high suppression (99%) after switch from non\u2010tenofovir\u2010based ART. Lower virologic suppression (85%) and high observed resistance levels (89%) in the tenofovir\u2010only group impact future treatment options, support recommendations for widespread VL monitoring in such resource limited settings to identify early treatment failure and suggest consideration of individualized resistance testing to design effective subsequent regimens.<\/jats:p><\/jats:sec>","DOI":"10.7448\/ias.19.1.20798","type":"journal-article","created":{"date-parts":[[2016,5,25]],"date-time":"2016-05-25T04:59:22Z","timestamp":1464152362000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Treatment failure and drug resistance in HIV\u2010positive patients on tenofovir\u2010based first\u2010line antiretroviral therapy in western Kenya"],"prefix":"10.1002","volume":"19","author":[{"given":"Katherine","family":"Brooks","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lameck","family":"Diero","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allison","family":"DeLong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maya","family":"Balamane","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marissa","family":"Reitsma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmanuel","family":"Kemboi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Millicent","family":"Orido","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wilfred","family":"Emonyi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mia","family":"Coetzer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Hogan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rami","family":"Kantor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,5,25]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"UNAIDS.How AIDS changed everything. 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