Low-level viraemia and other factors associated with virologic outcomes among children living with HIV on antiretroviral therapy in Kenya, 2017-2023: a retrospective longitudinal analysis.

@article{aoko2026lowlevel,
  title = {{Low-level viraemia and other factors associated with virologic outcomes among children living with HIV on antiretroviral therapy in Kenya, 2017-2023: a retrospective longitudinal analysis.}},
  author = {Appolonia Aoko and Sherri Pals and Susan Gachau and Lennah Omoto and Immaculate Mutisya and Bianca Alvarez and Kenneth Masamaro and Evelyn Ngugi and Frank Basiye and Cathy Toroitich-Ruto and Timothy Ngugi and Peter Yegon and Maureen Kimani and Lilly Nyagah and Lazarus Momanyi and Barbara Mambo and Nancy Bowen and Salome Okutoyi and Rachael Joseph and Helen M Chun},
  journal = {The Lancet regional health. Africa},
  year = {2026},
  month = jul,
  doi = {10.1016/j.lanafr.2026.100038},
  url = {https://europepmc.org/article/MED/42948502},
  note = {CC BY-NC},
}

TY  - JOUR
TI  - Low-level viraemia and other factors associated with virologic outcomes among children living with HIV on antiretroviral therapy in Kenya, 2017-2023: a retrospective longitudinal analysis.
AU  - Appolonia Aoko
AU  - Sherri Pals
AU  - Susan Gachau
AU  - Lennah Omoto
AU  - Immaculate Mutisya
AU  - Bianca Alvarez
AU  - Kenneth Masamaro
AU  - Evelyn Ngugi
AU  - Frank Basiye
AU  - Cathy Toroitich-Ruto
AU  - Timothy Ngugi
AU  - Peter Yegon
AU  - Maureen Kimani
AU  - Lilly Nyagah
AU  - Lazarus Momanyi
AU  - Barbara Mambo
AU  - Nancy Bowen
AU  - Salome Okutoyi
AU  - Rachael Joseph
AU  - Helen M Chun
PY  - 2026
DA  - 2026/07/01
JO  - The Lancet regional health. Africa
DO  - 10.1016/j.lanafr.2026.100038
UR  - https://europepmc.org/article/MED/42948502
AB  - Background  Kenya has expanded antiretroviral therapy (ART) coverage and improved viral suppression among children living with HIV (CLHIV). However, low-level viraemia (LLV) and clinical or programmatic factors may increase the risk of virologic failure (VF) and HIV drug resistance, threatening long-term treatment outcomes. We estimated LLV prevalence and its association with virologic outcomes among CLHIV in Kenya, along with other relevant factors.Methods  We conducted a retrospective analysis using data from Kenya's national HIV program database (2017-2023) for CLHIV aged 0-14 years on ART for ≥24 weeks with plasma-based viral load (VL) results. VL categories were undetectable VL (UVL; ≤50 copies/mL), LLV (51-999 copies/mL), and viral load non-suppression (VLNS; ≥1000 copies/mL). We assessed LLV prevalence and associations between initial VL and other factors with subsequent VLNS and VF (≥2 consecutive VLNS results) using non-time dependent and time-dependent multivariable models.Findings  Among 59,879 records, median age at initial VL was 7.6 years (IQR 4.2-11.3); 61.0% (36,524) had UVL, 20.6% (12,336) had LLV (51-199 copies/mL, 11.5% [6885]; 200-399 copies/mL, 4.7% [2785]; 400-999 copies/mL, 4.5% [2666]), and 18.4% (11,019) had VLNS. Across all VLs, 73.2% (43,843) achieved UVL, 29.7% (17,755) had LLV, and 4.4% (2614) experienced VF. Initial LLV increased risk of VLNS (adjusted relative risk [aRR] 1.87, 95% CI, 1.73-2.02) and VF (aRR 2.53, 95% CI, 2.03-3.15), highest at 400-999 copies/mL (VLNS aRR 2.64, 95% CI, 2.36-2.95); VF aRR 3.36, 95% CI, 2.46-4.59). Younger children (5-9 years) and those receiving dolutegravir-based ART had lower risk, while CLHIV in the Coast region had higher risk.Interpretation  These findings highlight the importance of timely viral load monitoring, practical adherence support interventions, and appropriate regimen review to address LLV in CLHIV and achieve sustained virologic suppression.Funding  This project was supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention (CDC).
SN  - 3050-5011
ER  -