{"doi":"10.1177/13596535221102690","title":"Acquired HIV drug resistance among adults living with HIV receiving first-line antiretroviral therapy in Rwanda: A cross-sectional nationally representative survey","abstract":"Background We assessed the prevalence of acquired HIV drug resistance (HIVDR) and associated factors among patients receiving first-line antiretroviral therapy (ART) in Rwanda. Methods This cross-sectional study included 702 patients receiving first-line ART for at least 6 months with last viral load (VL) results ≥1000 copies/mL. Blood plasma samples were subjected to VL testing; specimens with unsuppressed VL were genotyped to identify HIVDR-associated mutations. Data were analysed using STATA/SE. Results Median time on ART was 86.4 months (interquartile range [IQR], 44.8–130.2 months), and median CD4 count at ART initiation was 311 cells/mm 3 (IQR, 197–484 cells/mm 3 ). Of 414 (68.2%) samples with unsuppressed VL, 378 (88.3%) were genotyped. HIVDR included 347 (90.4%) non-nucleoside reverse transcriptase inhibitor- (NNRTI), 291 (75.5%) nucleoside reverse transcriptase inhibitor- (NRTI) and 13 (3.5%) protease inhibitor (PI) resistance-associated mutations. The most common HIVDR mutations were K65R (22.7%), M184V (15.4%) and D67N (9.8%) for NRTIs and K103N (34.4%) and Y181C/I/V/YC (7%) for NNRTIs. Independent predictors of acquired HIVDR included current ART regimen of zidovudine + lamivudine + nevirapine (adjusted odds ratio [aOR], 3.333 [95% confidence interval (CI): 1.022–10.870]; p = 0.046) for NRTI resistance and current ART regimen of tenofovir + emtricitabine + nevirapine (aOR, 0.148 [95% CI: 0.028–0.779]; p = 0.025), zidovudine + lamivudine + efavirenz (aOR, 0.105 [95% CI: 0.016–0.693]; p = 0.020) and zidovudine + lamivudine + nevirapine (aOR, 0.259 [95% CI: 0.084–0.793]; p = 0.019) for NNRTI resistance. History of ever switching ART regimen was associated with NRTI resistance (aOR, 2.53 [95% CI: 1.198–5.356]; p = 0.016) and NNRTI resistance (aOR, 3.23 [95% CI: 1.435–7.278], p = 0.005). Conclusion The prevalence of acquired HIV drug resistance (HIVDR) was high among patient failing to re-suppress VL and was associated with current ART regimen and ever switching ART regimen. The findings of this study support the current WHO guidelines recommending that patients on an NNRTI-based regimen should be switched based on a single viral load test and suggests that national HIV VL monitoring of patients receiving ART has prevented long-term treatment failure that would result in the accumulation of TAMs and potential loss of efficacy of all NRTI used in second-line ART as the backbone in combination with either dolutegravir or boosted PIs.","journal":"Antiviral Therapy","year":2022,"id":257512,"datarank":0.44166584687496613,"base_score":2.9444389791664403,"endowment":2.9444389791664403,"self_citation_contribution":0.44166584687496613,"citation_network_contribution":0.0,"self_endowment_contribution":0.44166584687496613,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":18,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8675,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":908010,"name":"Elysée Tuyishime","orcid":"0000-0002-3600-878X","position":1,"is_corresponding":false},{"id":908544,"name":"Athanase Kiromera","orcid":null,"position":2,"is_corresponding":false},{"id":704662,"name":"Samuel S. Malamba","orcid":"0000-0001-8087-8849","position":3,"is_corresponding":false},{"id":885354,"name":"Augustin Mulindabigwi","orcid":null,"position":4,"is_corresponding":false},{"id":908545,"name":"Madjid R. Habimana","orcid":null,"position":5,"is_corresponding":false},{"id":908546,"name":"Cyprien Baribwira","orcid":null,"position":6,"is_corresponding":false},{"id":333246,"name":"Muhayimpundu Ribakare","orcid":null,"position":7,"is_corresponding":false},{"id":908547,"name":"Savio D. Habimana","orcid":null,"position":8,"is_corresponding":false},{"id":548518,"name":"Joshua DeVos","orcid":"0000-0002-3306-1462","position":9,"is_corresponding":false},{"id":684526,"name":"Richard Nkunda","orcid":"0000-0002-4574-1000","position":10,"is_corresponding":false},{"id":885352,"name":"Eugenie Kayirangwa","orcid":null,"position":11,"is_corresponding":false},{"id":908548,"name":"Jules M. Semuhore","orcid":null,"position":12,"is_corresponding":false},{"id":581487,"name":"Gallican Rwibasira","orcid":"0000-0002-1559-6527","position":13,"is_corresponding":false},{"id":908011,"name":"Amitabh B. Suthar","orcid":"0000-0001-9756-6593","position":14,"is_corresponding":false},{"id":332413,"name":"Eric Remera","orcid":"0000-0002-6084-8877","position":15,"is_corresponding":false},{"id":884848,"name":"Gentille Musengimana","orcid":"0000-0002-9552-3298","position":0,"is_corresponding":true}],"reference_count":18,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T00:25:34.440699Z","pmid":"35593031","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}