ArticleFrontiers in public health2026
HIV treatment failure in tertiary care: clinical epidemiology and preliminary mechanistic characterisation.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Despite antiretroviral therapy (ART) scale-up in sub-Saharan Africa, treatment failure remains a significant challenge. We characterised virological and immunological outcomes among people living with HIV (PLHIV) attending tertiary care facilities in Nigeria, with exploratory analysis of potential mechanistic factors. Methods: This multi-centre cross-sectional study enrolled 517 HIV-positive adults from four Nigerian tertiary facilities between January 2019 and December 2021. Primary outcomes included viral load suppression (<1,000 copies/mL) and CD4 count. Exploratory mechanistic analyses examined drug resistance mutations ( Results: Among 412 participants with viral load data, only 111 (26.9%; 95% CI 22.7-31.5) achieved viral suppression, substantially below the UNAIDS 95% target. Of 387 with CD4 data, 149 (38.5%; 95% CI 33.6-43.6) had severe immunodeficiency (<200 cells/μL). Among 346 participants with complete data, discordant responses were common: 25.7% showed virological failure with preserved immunity, while 6.6% had immunological failure despite viral suppression. In pilot mechanistic subsets, 86% of viraemic participants harboured drug resistance mutations, with M184V (62%) and K103N (54%) predominating. CD8 T-cell activation (CD38+HLA-DR+) was significantly elevated in viraemic versus suppressed participants (median 28.6% vs. 12.4%; Conclusion: HIV treatment outcomes at Nigerian tertiary facilities fall substantially short of global targets. The high prevalence of discordant immune-virological responses and preliminary evidence of drug resistance and immune activation suggest multiple interacting pathways to treatment failure. Larger mechanistic studies are warranted to inform targeted interventions.
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