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
- 1School of Public Health, Guizhou University of Traditional Chinese Medicine
- 2Guiyang Public Health Clinical Center
- 3School of Geography and Environmental Science/Karst Research Institute, Guizhou Normal University
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.
Methods: 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.
Results: 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.
Conclusion: 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.
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BibTeX
@article{nie2026risk,
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}},
author = {Zongyu Nie and Yan Zheng and Liuying Yang and Shuanglian Ao and Hai Long and Peng Li},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1932794},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1932794/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - 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
AU - Zongyu Nie
AU - Yan Zheng
AU - Liuying Yang
AU - Shuanglian Ao
AU - Hai Long
AU - Peng Li
PY - 2026
DA - 2026/10/08
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1932794
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1932794/full
AB - 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. Methods: 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. Results: 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. Conclusion: 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.
SN - 2296-2565
ER -