{
  "abstract": "Objective: To investigate factors associated with low-level viremia (LLV) and virological failure (VF) in HIV patients who transitioned to second-line antiretroviral therapy (ART) after first-line ART failure, aiming to inform management strategies for virological fluctuations among second-line ART patients in resource-limited settings.\n\nMethods: This retrospective cohort study included HIV patients who switched to second-line ART regimens between January 1, 2000, and January 1, 2026, due to first-line ART failure. Baseline demographic data (e.g., age at diagnosis, sex) and clinical indicators (e.g., time from diagnosis to ART initiation, baseline viral load, baseline CD ₄ ⁺ T lymphocyte count) at enrollment were collected. LLV and VF were defined as outcomes. Cox proportional hazards regression models were used to evaluate the associations between baseline characteristics/clinical indicators and LLV and VF.\n\nResults: A baseline CD ₄ ⁺ T lymphocyte count ≥350 was associated with a lower hazard of both LLV (aHR, 0.82; 95% CI: 0.60–0.88) and VF (aHR, 0.49; 95% CI: 0.29–0.76). HIV infection through homosexual transmission was associated with a higher hazard of LLV (aHR, 3.69; 95% CI: 1.48–9.23). Use of DTG + 3TC + TDF as a second-line regimen was associated with a higher hazard of both LLV (aHR, 2.25; 95% CI: 1.31–5.82) and VF (aHR, 2.23; 95% CI: 1.32–3.25). Co-infection with hepatitis B was associated with a higher hazard of LLV (aHR, 2.12; 95% CI: 1.13–6.23), whereas HCV seropositivity was associated with a higher hazard of both LLV (aHR, 3.01; 95% CI: 1.78–7.48) and VF (aHR, 2.79; 95% CI: 1.52–6.14). The M184V mutation was associated with a higher hazard of LLV (aHR, 6.35; 95% CI: 1.44–27.93). Both M184V (aHR, 4.76; 95% CI: 1.02–19.63) and K103N (aHR, 10.00; 95% CI: 4.12–24.30) mutations were associated with a higher hazard of VF.\n\nConclusion: Lower baseline CD ₄ ⁺ T lymphocyte count, HIV infection through homosexual transmission, use of DTG + 3TC + TDF as a second-line regimen, hepatitis B co-infection or HCV seropositivity, and the presence of specific resistance-associated mutations were associated with a higher hazard of LLV and VF. Therefore, enhanced monitoring of resistance markers and immunological indicators is warranted among patients receiving second-line ART to facilitate timely clinical evaluation and treatment adjustment.",
  "abstract_shown": true,
  "affiliations": [
    "School of Public Health, Guizhou University of Traditional Chinese Medicine",
    "Guiyang Public Health Clinical Center",
    "School of Geography and Environmental Science/Karst Research Institute, Guizhou Normal University"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Zongyu Nie"
    },
    {
      "affs": [
        1
      ],
      "name": "Yan Zheng"
    },
    {
      "affs": [
        2
      ],
      "name": "Liuying Yang"
    },
    {
      "affs": [
        0
      ],
      "name": "Shuanglian Ao"
    },
    {
      "affs": [
        1
      ],
      "name": "Hai Long"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Peng Li"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/ea7r7vsefvk4f.bib",
  "cited_by": 0,
  "doi": "10.3389/fpubh.2026.1932794",
  "fulltext_url": "https://europepmc.org/articles/PMC13686987",
  "id": "ea7r7vsefvk4f",
  "issns": [
    "2296-2565"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1932794/full",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2725|HIV/AIDS drug development and treatment"
    ]
  ],
  "openalex": "W7221038643",
  "pdf_url": "https://europepmc.org/articles/PMC13686987?pdf=render",
  "pmcid": "PMC13686987",
  "pmid": "42922909",
  "published": "2026-10-08",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/ea7r7vsefvk4f.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:22Z",
      "native_id": "10.3389/fpubh.2026.1932794",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1932794/full"
    },
    {
      "first_seen": "2026-10-30T12:20:36Z",
      "native_id": "MED:42922909",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42922909"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2725|HIV/AIDS drug development and treatment",
      "subfield": "infectious-disease"
    }
  ],
  "title": "Risk factors for low-level viremia and virological failure in HIV patients in southwestern China who transitioned to second-line antiretroviral therapy after failure of first-line treatment: a retrospective cohort study",
  "title_text": "Risk factors for low-level viremia and virological failure in HIV patients in southwestern China who transitioned to second-line antiretroviral therapy after failure of first-line treatment: a retrospective cohort study",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:36Z",
  "url": "https://research.draconitic.com/paper/ea7r7vsefvk4f",
  "venue": "Frontiers in Public Health",
  "versions": []
}