Analysis of the Virological Failure Rates and Influencing Factors of ART Regimens Containing Integrase Inhibitors: A Retrospective Analysis from the Real World in Chongqing

Analysis of the Virological Failure Rates and Influencing Factors of ART Regimens Containing Integrase Inhibitors: A Retrospective Analysis from the Real World in Chongqing | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Analysis of the Virological Failure Rates and Influencing Factors of ART Regimens Containing Integrase Inhibitors: A Retrospective Analysis from the Real World in Chongqing Kun He, Yanming Zeng, Xiaoqing He, Xiang Du, Qi Cao, Juan Qian, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6577561/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: To assess the virological failure (VF) rate and determinants in treatment-naïve HIV patients using regimens with second-generation integrase inhibitors (INSTIs) in regions characterized by delayed diagnosis and advanced AIDS. Methods: We collected data from HIV-naïve patients who began antiretroviral therapy (ART) at Chongqing Public Health Medical Center between January 2018 and January 2023. Patients receiving second-generation INSTIs in their ART regimen were selected for study. Demographic information, clinical comorbidities, and laboratory test results before and after treatment, along with treatment compliance data, were gathered to calculate the VF rate. Independent risk factors for VF were analyzed via univariate and multivariate methods. Results: A total of 1,215 treatment-naïve HIV-infected individuals were screened for ART via a second-generation INSTIs regimen. Among them, 819 (67.41%) had baseline CD4+ T lymphocyte counts less than 200/µL, and 424 (34.90%) had baseline HIV RNA levels exceeding 500,000 copies/ml. The VF rate was 6.34% (77/1,215) at 48 weeks posttreatment. Univariate analysis revealed that baseline CD4+ T lymphocytes 500,000 copies/ml, coinfection with opportunistic infections, occurrence of low-level viremia (LLV), and poor drug adherence were risk factors for VF. Multivariate analysis confirmed that a baseline CD4+ T lymphocyte count <200/µL, LLV, and poor drug adherence were independent risk factors for VF. Among the 77 patients who experienced VF, 23 underwent HIV gene resistance testing, revealing integrase drug resistance mutations in 3 patients (13.04%). By December 2024, 58 of the 77 VF patients achieved successful virologic suppression (16 maintained the original regimen), 8 had HIV RNA levels between 50 and 200 copies/ml, and 11 had levels >200 copies/ml. Conclusion: In real-world scenarios where HIV is detected and treated late, second-generation INSTIs exhibit a high rate of VF However, the incidence of integrase drug resistance mutations among patients experiencing VF is low. Many patients achieve successful virologic suppression through enhanced adherence education while continuing their original regimen. Patients with a baseline CD4+ T lymphocyte count less than 200/µL, LLV, and poor drug adherence are at an elevated risk for treatment failure and warrant particular attention. AIDS second-generation integrase inhibitors virologic failure Figures Figure 1 Figure 2 Figure 3 Introduction For over 40 years, nonnucleoside reverse transcriptase inhibitors (NNRTIs) have been the predominant free antiretroviral therapy (ART) regimen for HIV/AIDS patients in China. A minority of patients opt for self-funded regimens centered on first-generation integrase inhibitors (INSTIs) due to intolerance to the side effects of the free drugs. Studies on ART regimens involving NNRTIs and first-generation INSTIs have reported VF rates between 10% and 20% [1–3]. Factors contributing to failure include low-level viremia (LLV), drug resistance, dual therapy, low baseline CD4 + T lymphocyte counts, and elevated baseline HIV-RNA levels. Currently, guidelines increasingly advocate the use of antiviral drugs with second-generation INSTIs as first-line treatments for HIV [4]. Randomized controlled trials (RCTs) have shown that these drugs not only exhibit few side effects and high tolerance but also offer significant advantages, such as rapid viral load reduction and a high resistance gene barrier. Previous RCTs reported that 98.6% of patients achieved virological suppression (HIV-RNA < 50 copies/ml) 48 weeks after treatment with these agents, and maintained a 98% suppression rate over a 240-week follow-up [5]. Thus, antiviral therapy centered on second-generation INSTIs has a high success rate. In practice, patient conditions often diverge from those in RCTs. Nearly all RCT participants undergo pretreatment resistance testing and typically exhibit greater adherence to treatment protocols than real-world patients do. Compared with the results from RCTs, real-world studies have reported lower viral suppression rates, ranging from 85.8–94.3% [6–8]. Moreover, these studies predominantly focused on European and American populations, with baseline HIV-RNA levels primarily below 100,000 and a majority of patients having CD4 + T lymphocyte counts ≥ 200/µL, limiting their generalizability. In Southwest China, late detection and treatment of HIV are critical issues. A significant proportion of patients present with baseline HIV-RNA levels exceeding 100,000 copies/mL, with 30% surpassing 500,000 copies/mL, and over half have CD4 + T lymphocyte counts below 200 cells/µL. Additionally, most patients lack baseline HIV drug resistance testing [9]. Nearly half of patients are over 50 years old, have low educational attainment, and exhibit poor medication adherence. Despite the need for better treatment regimens under these conditions, there is insufficient large-scale research on the efficacy of second-generation INSTIs regimens in achieving viral suppression, particularly when dual versus triple regimens are compared. Our preliminary survey of over 200 patients indicated a 98.5% virological suppression rate after 48 weeks with a triple regimen containing second-generation INSTIs. To further assess the effectiveness of such regimens in late-detection and late-treatment populations, identify treatment failure causes, and explore subsequent interventions for virological failure, this study retrospectively analyzed the treatment outcomes of 1,215 patients. Methods Patients We collected data on HIV treatment-naïve patients who began ART at Chongqing Public Health Medical Center between January 2018 and January 2023. Patients whose ART regimens included second-generation INSTIs were chosen for the study. All participants underwent blood testing, and HIV infection was confirmed via Western blot analysis. Figure 1 shows the study flow chart. Data and information collection Data on baseline demographic and clinical characteristics, including sex; age at HIV diagnosis; interval from HIV diagnosis to ART initiation; inpatient or outpatient status at HIV diagnosis; presence of AIDS-defining opportunistic illnesses; and HBV, HCV, and syphilis coinfection, were collected. In addition, laboratory results such as CD4 + T-lymphocyte count, HIV-1 RNA, HIV-1 subtype strains, and genotypic resistance tests were also included in the analysis. Definitions VF was defined as HIV RNA levels exceeding 200 copies/ml in two consecutive tests after 48 weeks of antiviral therapy. Successful virological suppression is characterized by HIV RNA levels below 50 copies/ml in clinical tests following 48 weeks of treatment. LLV is indicated by HIV RNA levels between 50 and 200 copies/ml in one or more tests after 48 weeks of therapy. Adherence poor: a patient is considered not adherent if one or more of the four first questions were answered affirmatively, if the patient missed more than two doses in the past week or if there were more than two days without medication during the past 3 months. Laboratory testing methods Venous blood was collected via EDTA anticoagulant tubes, and plasma was collected via centrifugation. The plasma was then frozen at -80°C until use. According to the manufacturer's instructions, the HIV-1 RNA load was quantified via COBAS Ampliperp/TaqMan 48 real-time RT‒PCR detection (Roche, Germany), with a quantification limit of 20 RNA copies per milliliter. The CD4 + count was evaluated via a BD FACSCanto II flow cytometer (BD Biosciences, USA). Resistance-associated mutations were interpreted according to the HIV drug resistance interpretation program of the Stanford University HIV Drug Resistance Database[10]. Statistical analysis All study data were analyzed via IBM-SPSS Statistics software, version 25.0 (IBM-SPSS Statistics, Armonk, New York, USA). Standard descriptive statistics were used to analyze the demographic and clinical characteristics as well as the laboratory results of the patients. Continuous variables with a normal distribution are reported as the means ± standard deviations (SDs), whereas continuous variables with a nonnormal distribution are presented as medians with interquartile ranges. Logistic regression analysis was used to analyze risk factors for patients with virological failure. Results Basic information A total of 1,215 patients were screened, comprising 956 men (78.68%), 511 individuals (42.06%) over 50 years old, 819 patients (67.41%) with baseline CD4 + T lymphocytes 500,000 copies/mL, and 190 patients (15.64%) with opportunistic infections within one month prior to ART initiation. The prevalence rates of syphilis, hepatitis B, and hepatitis C were 25.02%, 8.31%, and 3.13%, respectively. Post-ART treatment, 98 patients (8.07%) had poor drug compliance, and 211 patients (17.37%) experienced at least one episode of LLV following successful virologic suppression at 48 weeks of ART; however, these patients were classified as successful treatments for analysis. Among the cohort, 326 patients received the 2-nucleoside + BIC regimen, whereas 889 received the DTG-containing regimen (223 received the 3TC + DTG regimen, and the remainder received the 2-nucleoside + DTG regimen). At approximately 12 weeks after 48 weeks of ART, 77 patients (6.34%) were diagnosed with VF. The specific data are shown in Table 1 . Table 1 Basic information of enrolled patients Project Category Total N = 1215 Virology successful N = 1138 Virological failure N = 77 Sex male 956(78.68%) 901(79.17%) 55(71.43%) female 259(21.32%) 237(20.83%) 22(28.57%) Age(years) 15–34 386(31.77%) 368(32.34%) 18(23.38%) 35–49 318(26.17%) 295(25.92%) 23(29.87%) ≥ 50 511(42.06%) 475(41.74%) 36(46.75%) ART after HIV diagnosis(days) 0–14 584(48.07%) 554(48.68%) 30(38.96%) 15–30 295(24.28%) 270(23.73%) 25(32.47%) >30 336(27.65%) 314(27.59%) 22(28.57%) Baseline CD4 + T-lymphocyte <200 819(67.41%) 755(66.34%) 64(83.12%) ≥ 200 396(32.59%) 383(33.66%) 13(16.88%) Baseline HIV RNA(copies/ml) 500,000 copies/ml 424(34.90%) 386(33.92%) 38(49.35%) With or without opportunistic infections With 190(15.64%) 169(14.85%) 21(27.27%) Without 1025(84.36%) 969(85.15%) 56(72.73%) With or without Hepatitis B With 101(8.31%) 97(8.52%) 4(5.19%) Without 1114(91.69%) 1041(91.48%) 73(94.81%) With or without Hepatitis C With 38(3.13%) 33(2.90%) 5(6.49%) Without 1177(96.87%) 1105(97.10%) 72(93.51%) With or without syphilis With 304(25.02%) 278(24.43%) 26(33.77%) Without 911(75.98%) 860(75.57%) 51(66.23%) With or Without LLV With 211(17.37%) 159(13.97%) 52(67.53%) Without 1004(82.63%) 979(86.03%) 25(32.47%) Adherence poor 98(8.07%) 54(4.75%) 44(51.95%) good 1117(91.93%) 1084(95.25%) 33(42.86%) ART Dual drug therapy 223(18.35%) 206(18.10%) 17(22.08%) Triple drug therapy 992(81.65%) 932(81.90%) 60(77.92%) Factors influencing the occurrence of VF in newly diagnosed patients with AIDS The study analyzed factors influencing VF by categorizing groups based on treatment outcomes. Univariate analysis revealed no significant impact of sex, age, syphilis coinfection, hepatitis B, hepatitis C, or ART regimen on VF (all p > 0.05). However, baseline CD4 + T lymphocytes 500,000 copies/ml, opportunistic infections, LLV, and poor drug adherence were identified as significant factors (all p < 0.05). Multivariate analysis confirmed that a baseline CD4 + T lymphocyte count < 200/µL, LLV, and poor drug adherence were independent risk factors for VF (all p < 0.05). The results are shown in Table 2 . Table 2 Risk factors for treatment failure in HIV patients: logistic univariate analysis Project Category p OR 95%CI p OR 95%CI Sex/female 0.110 1.521 0.909–2.544 Age(years) 15–34 - 1 - 35–49 0.150 1.594 0.844–3.009 ≥ 50 0.140 1.549 0.866–2.773 With opportunistic infections 0.004 2.150 1.269–3.644 0.266 1.456 0.751–2.820 Baseline CD4 + T-lymphocyte <200 0.003 2.497 1.359–4.591 0.037 2.186 1.048–4.557 Baseline HIV RNA(copies/ml) 500,000 copies/ml 0.022 1.888 1.097–3.250 0.304 1.442 0.717–2.901 ART after HIV diagnosis(days) 0–14 15–30 0.056 1.710 0.986–2.965 >30 0.373 1.294 0.734–2.282 ART regimen/dual therapy 0.141 1.500 0.874–2.573 With Hepatitis B 0.311 0.588 0.210–1.643 With Hepatitis C 0.088 2.325 0.881–6.136 With syphilis 0.069 1.577 0.965–2.578 With LLV <0.001 12.807 7.725–21.234 <0.001 14.681 7.833–27.516 Adherence/poor <0.001 20.130 11.977–33.836 <0.001 28.998 14.814–56.763 ART Dual drug therapy - 1 - Triple drug therapy 0.141 1.500 0.874–2.573 Treatment Failures: HIV drug resistance status and subsequent treatment outcomes HIV genetic resistance testing was conducted on 29 of the 77 patients identified as treatment failures. Results were obtained for 23 patients, while viral amplification failed in 6 patients. Testing was not completed in 48 patients due to financial constraints or other reasons. Among the 23 patients with results, 16 (69.57%) presented with drug resistance mutations: 12 (52.17%) presented with nucleoside resistance mutations, 10 presented with M184v mutations, 10 (43.48%) presented with nonnucleoside resistance mutations, and 3 (13.04%) presented with integrase inhibitor resistance mutations. Figure 2 shows detailed drug resistance site information. Among 77 patients monitored after treatment failure, 58 (75.32%) achieved virological suppression (HIV-RNA < 50 copies/ml) by December 2024. Sixteen (27.59%) of these patients continued their initial regimen, 14 (24.14%) modified their regimen based on drug resistance reports, and 28 (48.28%) adjusted their regimen empirically. Notably, 33 of the 58 patients (56.90%) remained on a second-generation integrase inhibitor regimen. Additionally, 8 patients (10.39%) had HIV-RNA levels between 50 and 200 copies/ml, and 11 (14.29%) had levels exceeding 200 copies/ml. Figure 3 shows the management and treatment outcomes of 77 patients. Discussion Second-generation INSTIs, such as DTG and BIC, are endorsed as first-line treatments in all HIV guidelines [4]. This study analyzed data from 1,215 HIV-positive patients in Chongqing. Among these patients, 63.46% had baseline HIV-RNA levels exceeding 100,000 copies/ml, 34.90% exceeded 500,000 copies/ml, 67.41% had baseline CD4 counts below 200, and 42.06% were over 50 years old. This study addresses the gap in real-world efficacy data for second-generation INSTIs, particularly in the contexts of late detection, delayed treatment, and the absence of baseline resistance testing, offering a comprehensive view of their effectiveness in practice. This study is the first to evaluate the efficacy of second-generation INSTIs in newly infected HIV patients in Southwest China and to directly investigate the causes of VF in this region. The VF rate at one year with this regimen was 6.34% (77/1215), which was significantly lower than the 10.3% observed with nonintegrase inhibitor regimens, such as NNRTI-based ART (viral load ≥ 200 copies/mL) [11]. The B/F/TAF regimen outperformed bDRV-based regimens in achieving virological suppression, regardless of whether the criterion was HIV RNA < 50 copies/mL or < 200 copies/mL [12]. However, compared with RCTs, there remains a substantial gap in efficacy, with an effective rate less than 95% within one year, which falls short of the World Health Organization's (WHO) target. Thus, in populations at high risk of treatment failure, it is crucial to identify risk factors and implement intervention strategies to increase the success rate of antiviral therapy. To elucidate the characteristics of high-risk populations for treatment failure, both univariate and multivariate analyses were conducted. Univariate analysis identified factors contributing to VF as baseline HIV-RNA > 500,000 copies/mL, baseline CD4 + T lymphocytes < 200/µL, concurrent opportunistic infections, poor treatment adherence, and LLV. Independent risk factors included baseline CD4 + T lymphocytes < 200/µL, poor adherence, and LLV. Patients with baseline CD4 + T lymphocytes < 200/µL and opportunistic infections are in advanced AIDS stages. In addition to ART, these patients may require additional medications, such as antituberculosis drugs, antifungal drugs, and corticosteroids, which can interact with ART, affecting drug concentrations and leading to treatment failure [13]. Advanced AIDS patients are also susceptible to cancers, particularly intestinal cancer, which can cause treatment failure and induce HIV resistance, even with good adherence. Although the dual regimen's efficacy and safety are well established, this study did not find an increased VF risk associated with it, despite potential confounding from patients with high baseline viral loads not included in the dual treatment arm. This study demonstrated that LLV increases the risk of VF, which aligns with previous findings. LLV perpetuates viral replication, replenishing latent reservoirs that sustain the presence of the virus [14–16]. LLV was notably prevalent among patients with delayed detection and poor adherence to treatment [17]. Despite the advantages of second-generation INSTIs, including reduced tablet burden and minimal side effects, 17.37% of patients in this study exhibited LLV. Prompt attention should be given to the occurrence of LLV. The etiology of LLV remains uncertain, although prior research suggests that it may result from intermittent proviral release with limited replication capacity. Additionally, factors such as drug interactions and poor adherence can impair pharmacokinetics, diminishing antiviral efficacy and inducing LLV. Enhanced monitoring of HIV RNA or DNA drug resistance and blood drug concentrations is recommended, with timely interventions as needed. There is no consensus on altering ART regimens for unexplained persistent LLV, so this warrants further investigation. Achieving virological success requires both selecting the appropriate drug and ensuring medication adherence. Even with regimens featuring high resistance gene barriers, such as those with second-generation INSTIs, poor adherence significantly increases the risk of treatment failure. In this study, 8.07% of patients exhibited poor adherence, and among the 77 patients who experienced VF, 52% had poor compliance. In China, only 68.3% of patients achieved ≥ 95% adherence by the third month of ART, whereas in the United States, adherence ranged from 67.7–83.5% [18–19]. Poor adherence poses a major challenge to AIDS prevention and control efforts. Enhancing educational outreach, improving patient awareness and initiatives for standardized medication use, and establishing a comprehensive "prevention-treatment-care" model through multidepartmental services are essential to improving adherence. The 2024 guidelines from China emphasize the importance of closely monitoring HIV RNA in newly infected individuals to promptly identify VF, analyze its causes, and adjust treatment strategies accordingly [20]. This approach ensures effective follow-up after timely detection of HIV resistance. In this study, 77 patients experienced treatment failure; however, only 23 underwent HIV drug resistance testing due to economic constraints; this underscores the need for increased public health investment and enhanced laboratory capabilities to ensure comprehensive drug resistance testing for all patients experiencing treatment failure. Among the 23 strains tested, 16 (69.57%) exhibited drug resistance mutations, with a 52.17% incidence of nucleoside drug resistance and a 13.04% incidence of integrase resistance, confirming the greater resistance barrier of second-generation INSTIs. Over 85% of patients with treatment failure did not develop mutations at resistance sites for these drugs, allowing their continued use in subsequent ART regimens. A follow-up of the 77 VF patients revealed that 58 achieved successful viral suppression, with 33 continuing to receive anti-HIV therapy incorporating second-generation INSTIs. This study has several limitations. First, pretreatment HIV RNA resistance testing to assess potential transmission resistance factors contributing to treatment failure is lacking. Second, the compliance analysis was rudimentary; it identified variations in virologic outcomes among patients with poor compliance but failed to explore the relationship between varying degrees of noncompliance and treatment efficacy. Finally, the study did not specifically analyze the types of opportunistic infections, making it impossible to determine whether different types and sites of these infections affect the success of virological suppression differently. Conclusion This study significantly advances our understanding of the efficacy of ART regimens incorporating second-generation INSTIs. Despite a high treatment failure rate in Southwest China—attributable to late detection, delayed treatment, a substantial elderly population, high baseline viral loads, and low CD4 counts—the incidence of integrase drug resistance mutations among patients experiencing treatment failure was low. Many patients achieve successful virological suppression through improved compliance education while maintaining their original regimen. This study identified patients with baseline CD4+ T lymphocyte counts less than 200/µL, LLV, and poor treatment adherence as high-risk patients for treatment failure, underscoring the need for targeted early interventions to mitigate this risk. Abbreviations VF: virological failure; INSTIs: integrase inhibitors; ART: antiretroviral therapy; LLV: low-level viremia; NNRTIs: nonnucleoside reverse transcriptase inhibitors; RCTs: randomized controlled trials. Declarations Ethics approval The study protocol was approved by the Ethics Committee of Chongqing Public Health Medical Center (2024-017-01-KY). Since the present study was retrospective and all patients' data were analyzed anonymously, the institutional review board waived the requirement for written informed consent. Clinical trial number not applicable. Consent for publication Not applicable. Availability of data and materials The raw data may be requested from the first author and corresponding author, with administrative permissions of the review board of the Chongqing Public Health Medical Center, first author and corresponding author. All patient data has been de-identified. Competing interests All authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Funding The first batch of key public health disciplines (specialties) in Chongqing. Chongqing Science and Health Joint Medical Research Project (2024MSXM117) Authors’ contributions Study design: ML and HL. Collection and interpretation of data: KH and YMZ, XQH, QC, XD, JQ and MJL. Statistical analyses and drafting of manuscript: KH and YMZ. Review of manuscript for important intellectual content: HLand ML. 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Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi , 40 (1), 52–57. https://doi.org/10.3760/cma.j.issn.0253-2727.2019.01.010 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6577561","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":495447288,"identity":"1a37e2e2-42be-447e-9b44-cc840c170ad4","order_by":0,"name":"Kun He","email":"","orcid":"","institution":"Chongqing Public Health Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Kun","middleName":"","lastName":"He","suffix":""},{"id":495447290,"identity":"6f3ca367-fc88-44d7-8607-e17845812489","order_by":1,"name":"Yanming Zeng","email":"","orcid":"","institution":"Chongqing Public Health Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Yanming","middleName":"","lastName":"Zeng","suffix":""},{"id":495447291,"identity":"03fc73db-9826-4884-acfc-d593aa5a2e6a","order_by":2,"name":"Xiaoqing He","email":"","orcid":"","institution":"Chongqing Public Health Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Xiaoqing","middleName":"","lastName":"He","suffix":""},{"id":495447293,"identity":"b362d943-b967-41ac-bb34-42b614228376","order_by":3,"name":"Xiang Du","email":"","orcid":"","institution":"Chongqing Public Health Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Xiang","middleName":"","lastName":"Du","suffix":""},{"id":495447294,"identity":"fdb37289-f945-4074-b500-4ba58017e3fb","order_by":4,"name":"Qi Cao","email":"","orcid":"","institution":"Chongqing Public Health Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Qi","middleName":"","lastName":"Cao","suffix":""},{"id":495447296,"identity":"bd11f767-0f13-4306-b31f-63f2cc8e6244","order_by":5,"name":"Juan Qian","email":"","orcid":"","institution":"Chongqing Public Health Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Juan","middleName":"","lastName":"Qian","suffix":""},{"id":495447299,"identity":"1b123720-44ec-4dad-a410-92e4424e9074","order_by":6,"name":"Mingjun Li","email":"","orcid":"","institution":"Chongqing Public Health Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Mingjun","middleName":"","lastName":"Li","suffix":""},{"id":495447301,"identity":"f1faaec0-d5ad-494e-a385-2c9bce6a03a6","order_by":7,"name":"Huan Li","email":"","orcid":"","institution":"Chongqing Public Health Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Huan","middleName":"","lastName":"Li","suffix":""},{"id":495447302,"identity":"f378d177-f31e-4a31-a6ec-ed876774627e","order_by":8,"name":"Min Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIiWNgGAWjYLCCBwYMDGwMzAc+gDhs7MRoSQBrYUucAdbCTJQWMMljCNbCQEiLfET6M4mEgsPRfNI9Hxs+tm2T52NmYPzwMQe3FsMbCckGCQaHc9tkzm5snHHmtmEbMwOz5MxteLTMTjj4AKxFInf7Y56K24xALWzMvHi1JDYcgGjJedjMY3DbnqAWeelkRqgtOYzNQFsSCWoxkH/GDPRLOlBLmiHIL8ltzIzNeP0i33P8mcSHP9a582ckPwSG2G3b+e3NBz98xGfLAUwxxgbc6kG24JceBaNgFIyCUQAEABtaUU8R9ZySAAAAAElFTkSuQmCC","orcid":"","institution":"Chongqing Public Health Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Min","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2025-05-02 10:23:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6577561/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6577561/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88490847,"identity":"72e10cf9-fc4b-4038-86df-48e1c37f342e","added_by":"auto","created_at":"2025-08-07 04:16:24","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":75507,"visible":true,"origin":"","legend":"\u003cp\u003eStudy flow chart.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6577561/v1/2764f1e595076968a9255d91.png"},{"id":88490846,"identity":"9a014a08-8671-46f7-93cd-dfcef755fe65","added_by":"auto","created_at":"2025-08-07 04:16:24","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":40686,"visible":true,"origin":"","legend":"\u003cp\u003eDrug resistance after VF\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6577561/v1/f8a43bdfd8c2a2a22b4ef2b0.png"},{"id":88492458,"identity":"eeac7448-72e0-41ab-8c05-e9374b032248","added_by":"auto","created_at":"2025-08-07 04:32:24","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":82678,"visible":true,"origin":"","legend":"\u003cp\u003eIllustrates the management and treatment outcomes for 77 patients\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6577561/v1/eb44d84da51ccf0d9234aa8b.png"},{"id":106394635,"identity":"5e8bc232-30ec-457f-ac3a-4ab801c00be7","added_by":"auto","created_at":"2026-04-08 07:44:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":973175,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6577561/v1/b07a1f4c-17f7-4899-a0a0-b139ad57747f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis of the Virological Failure Rates and Influencing Factors of ART Regimens Containing Integrase Inhibitors: A Retrospective Analysis from the Real World in Chongqing","fulltext":[{"header":"Introduction","content":"\u003cp\u003eFor over 40 years, nonnucleoside reverse transcriptase inhibitors (NNRTIs) have been the predominant free antiretroviral therapy (ART) regimen for HIV/AIDS patients in China. A minority of patients opt for self-funded regimens centered on first-generation integrase inhibitors (INSTIs) due to intolerance to the side effects of the free drugs. Studies on ART regimens involving NNRTIs and first-generation INSTIs have reported VF rates between 10% and 20% [1\u0026ndash;3]. Factors contributing to failure include low-level viremia (LLV), drug resistance, dual therapy, low baseline CD4\u0026thinsp;+\u0026thinsp;T lymphocyte counts, and elevated baseline HIV-RNA levels. Currently, guidelines increasingly advocate the use of antiviral drugs with second-generation INSTIs as first-line treatments for HIV [4]. Randomized controlled trials (RCTs) have shown that these drugs not only exhibit few side effects and high tolerance but also offer significant advantages, such as rapid viral load reduction and a high resistance gene barrier. Previous RCTs reported that 98.6% of patients achieved virological suppression (HIV-RNA\u0026thinsp;\u0026lt;\u0026thinsp;50 copies/ml) 48 weeks after treatment with these agents, and maintained a 98% suppression rate over a 240-week follow-up [5]. Thus, antiviral therapy centered on second-generation INSTIs has a high success rate.\u003c/p\u003e\u003cp\u003eIn practice, patient conditions often diverge from those in RCTs. Nearly all RCT participants undergo pretreatment resistance testing and typically exhibit greater adherence to treatment protocols than real-world patients do. Compared with the results from RCTs, real-world studies have reported lower viral suppression rates, ranging from 85.8\u0026ndash;94.3% [6\u0026ndash;8]. Moreover, these studies predominantly focused on European and American populations, with baseline HIV-RNA levels primarily below 100,000 and a majority of patients having CD4\u0026thinsp;+\u0026thinsp;T lymphocyte counts\u0026thinsp;\u0026ge;\u0026thinsp;200/\u0026micro;L, limiting their generalizability. In Southwest China, late detection and treatment of HIV are critical issues. A significant proportion of patients present with baseline HIV-RNA levels exceeding 100,000 copies/mL, with 30% surpassing 500,000 copies/mL, and over half have CD4\u0026thinsp;+\u0026thinsp;T lymphocyte counts below 200 cells/\u0026micro;L. Additionally, most patients lack baseline HIV drug resistance testing [9]. Nearly half of patients are over 50 years old, have low educational attainment, and exhibit poor medication adherence. Despite the need for better treatment regimens under these conditions, there is insufficient large-scale research on the efficacy of second-generation INSTIs regimens in achieving viral suppression, particularly when dual versus triple regimens are compared. Our preliminary survey of over 200 patients indicated a 98.5% virological suppression rate after 48 weeks with a triple regimen containing second-generation INSTIs. To further assess the effectiveness of such regimens in late-detection and late-treatment populations, identify treatment failure causes, and explore subsequent interventions for virological failure, this study retrospectively analyzed the treatment outcomes of 1,215 patients.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003ePatients\u003c/h2\u003e\u003cp\u003eWe collected data on HIV treatment-na\u0026iuml;ve patients who began ART at Chongqing Public Health Medical Center between January 2018 and January 2023. Patients whose ART regimens included second-generation INSTIs were chosen for the study. All participants underwent blood testing, and HIV infection was confirmed via Western blot analysis. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the study flow chart.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData and information collection\u003c/h3\u003e\n\u003cp\u003eData on baseline demographic and clinical characteristics, including sex; age at HIV diagnosis; interval from HIV diagnosis to ART initiation; inpatient or outpatient status at HIV diagnosis; presence of AIDS-defining opportunistic illnesses; and HBV, HCV, and syphilis coinfection, were collected. In addition, laboratory results such as CD4\u0026thinsp;+\u0026thinsp;T-lymphocyte count, HIV-1 RNA, HIV-1 subtype strains, and genotypic resistance tests were also included in the analysis.\u003c/p\u003e\n\u003ch3\u003eDefinitions\u003c/h3\u003e\n\u003cp\u003eVF was defined as HIV RNA levels exceeding 200 copies/ml in two consecutive tests after 48 weeks of antiviral therapy.\u003c/p\u003e\u003cp\u003eSuccessful virological suppression is characterized by HIV RNA levels below 50 copies/ml in clinical tests following 48 weeks of treatment.\u003c/p\u003e\u003cp\u003eLLV is indicated by HIV RNA levels between 50 and 200 copies/ml in one or more tests after 48 weeks of therapy.\u003c/p\u003e\u003cp\u003eAdherence poor: a patient is considered not adherent if one or more of the four first questions were answered affirmatively, if the patient missed more than two doses in the past week or if there were more than two days without medication during the past 3 months.\u003c/p\u003e\n\u003ch3\u003eLaboratory testing methods\u003c/h3\u003e\n\u003cp\u003eVenous blood was collected via EDTA anticoagulant tubes, and plasma was collected via centrifugation. The plasma was then frozen at -80\u0026deg;C until use. According to the manufacturer's instructions, the HIV-1 RNA load was quantified via COBAS Ampliperp/TaqMan 48 real-time RT‒PCR detection (Roche, Germany), with a quantification limit of 20 RNA copies per milliliter. The CD4\u0026thinsp;+\u0026thinsp;count was evaluated via a BD FACSCanto II flow cytometer (BD Biosciences, USA). Resistance-associated mutations were interpreted according to the HIV drug resistance interpretation program of the Stanford University HIV Drug Resistance Database[10].\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eAll study data were analyzed via IBM-SPSS Statistics software, version 25.0 (IBM-SPSS Statistics, Armonk, New York, USA). Standard descriptive statistics were used to analyze the demographic and clinical characteristics as well as the laboratory results of the patients. Continuous variables with a normal distribution are reported as the means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations (SDs), whereas continuous variables with a nonnormal distribution are presented as medians with interquartile ranges. Logistic regression analysis was used to analyze risk factors for patients with virological failure.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003eBasic information\u003c/h2\u003e\n \u003cp\u003eA total of 1,215 patients were screened, comprising 956 men (78.68%), 511 individuals (42.06%) over 50 years old, 819 patients (67.41%) with baseline CD4\u0026thinsp;+\u0026thinsp;T lymphocytes\u0026thinsp;\u0026lt;\u0026thinsp;200/\u0026micro;L, 424 patients (34.90%) with baseline HIV RNA\u0026thinsp;\u0026gt;\u0026thinsp;500,000 copies/mL, and 190 patients (15.64%) with opportunistic infections within one month prior to ART initiation. The prevalence rates of syphilis, hepatitis B, and hepatitis C were 25.02%, 8.31%, and 3.13%, respectively. Post-ART treatment, 98 patients (8.07%) had poor drug compliance, and 211 patients (17.37%) experienced at least one episode of LLV following successful virologic suppression at 48 weeks of ART; however, these patients were classified as successful treatments for analysis. Among the cohort, 326 patients received the 2-nucleoside\u0026thinsp;+\u0026thinsp;BIC regimen, whereas 889 received the DTG-containing regimen (223 received the 3TC\u0026thinsp;+\u0026thinsp;DTG regimen, and the remainder received the 2-nucleoside\u0026thinsp;+\u0026thinsp;DTG regimen). At approximately 12 weeks after 48 weeks of ART, 77 patients (6.34%) were diagnosed with VF. The specific data are shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBasic information of enrolled patients\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eProject Category\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;1215\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVirology successful\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;1138\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVirological failure\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;77\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e956(78.68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e901(79.17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e55(71.43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e259(21.32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e237(20.83%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22(28.57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge(years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u0026ndash;34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e386(31.77%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e368(32.34%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18(23.38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u0026ndash;49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e318(26.17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e295(25.92%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23(29.87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e511(42.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e475(41.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36(46.75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eART after HIV diagnosis(days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e584(48.07%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e554(48.68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30(38.96%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e295(24.28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e270(23.73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25(32.47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e336(27.65%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e314(27.59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22(28.57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBaseline CD4\u0026thinsp;+\u0026thinsp;T-lymphocyte\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e819(67.41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e755(66.34%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e64(83.12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e396(32.59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e383(33.66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13(16.88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBaseline HIV RNA(copies/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;100,000copies/ml\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e444(36.54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e422(37.08%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22(28.57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100,000-500,000 copies/ml\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e347(28.56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e330(29.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17(22.08%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;500,000 copies/ml\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e424(34.90%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e386(33.92%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38(49.35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith or without opportunistic infections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e190(15.64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e169(14.85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21(27.27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1025(84.36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e969(85.15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e56(72.73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith or without Hepatitis B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e101(8.31%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e97(8.52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4(5.19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1114(91.69%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1041(91.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e73(94.81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith or without Hepatitis C\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38(3.13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33(2.90%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5(6.49%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1177(96.87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1105(97.10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e72(93.51%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith or without syphilis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e304(25.02%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e278(24.43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26(33.77%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e911(75.98%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e860(75.57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e51(66.23%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith or Without LLV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e211(17.37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e159(13.97%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e52(67.53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1004(82.63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e979(86.03%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25(32.47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdherence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003epoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e98(8.07%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54(4.75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44(51.95%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003egood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1117(91.93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1084(95.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33(42.86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eART\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDual drug therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e223(18.35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e206(18.10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17(22.08%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTriple drug therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e992(81.65%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e932(81.90%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60(77.92%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eFactors influencing the occurrence of VF in newly diagnosed patients with AIDS\u003c/h3\u003e\n\u003cp\u003eThe study analyzed factors influencing VF by categorizing groups based on treatment outcomes. Univariate analysis revealed no significant impact of sex, age, syphilis coinfection, hepatitis B, hepatitis C, or ART regimen on VF (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, baseline CD4\u0026thinsp;+\u0026thinsp;T lymphocytes\u0026thinsp;\u0026lt;\u0026thinsp;200/\u0026micro;L, baseline HIV RNA\u0026thinsp;\u0026gt;\u0026thinsp;500,000 copies/ml, opportunistic infections, LLV, and poor drug adherence were identified as significant factors (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Multivariate analysis confirmed that a baseline CD4\u0026thinsp;+\u0026thinsp;T lymphocyte count\u0026thinsp;\u0026lt;\u0026thinsp;200/\u0026micro;L, LLV, and poor drug adherence were independent risk factors for VF (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The results are shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eRisk factors for treatment failure in HIV patients: logistic univariate analysis\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eProject Category\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex/female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.521\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.909\u0026ndash;2.544\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge(years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u0026ndash;34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u0026ndash;49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.594\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.844\u0026ndash;3.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.549\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.866\u0026ndash;2.773\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith opportunistic infections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.269\u0026ndash;3.644\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.266\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.456\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.751\u0026ndash;2.820\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBaseline CD4\u0026thinsp;+\u0026thinsp;T-lymphocyte \u0026lt;200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.497\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.359\u0026ndash;4.591\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.048\u0026ndash;4.557\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBaseline HIV RNA(copies/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;100,000copies/ml\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100,000-500,000 copies/ml\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.971\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.988\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.516\u0026ndash;1.891\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.797\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.498\u0026ndash;2.480\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;500,000 copies/ml\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.888\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.097\u0026ndash;3.250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.304\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.442\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.717\u0026ndash;2.901\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eART after HIV diagnosis(days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.710\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.986\u0026ndash;2.965\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.373\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.294\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.734\u0026ndash;2.282\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eART regimen/dual therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.874\u0026ndash;2.573\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith Hepatitis B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.588\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.210\u0026ndash;1.643\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith Hepatitis C\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.325\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.881\u0026ndash;6.136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith syphilis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.577\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.965\u0026ndash;2.578\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith LLV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.807\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.725\u0026ndash;21.234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.681\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.833\u0026ndash;27.516\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdherence/poor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.977\u0026ndash;33.836\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28.998\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.814\u0026ndash;56.763\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eART\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDual drug therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTriple drug therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.874\u0026ndash;2.573\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eTreatment Failures: HIV drug resistance status and subsequent treatment outcomes\u003c/h2\u003e\n \u003cp\u003eHIV genetic resistance testing was conducted on 29 of the 77 patients identified as treatment failures. Results were obtained for 23 patients, while viral amplification failed in 6 patients. Testing was not completed in 48 patients due to financial constraints or other reasons. Among the 23 patients with results, 16 (69.57%) presented with drug resistance mutations: 12 (52.17%) presented with nucleoside resistance mutations, 10 presented with M184v mutations, 10 (43.48%) presented with nonnucleoside resistance mutations, and 3 (13.04%) presented with integrase inhibitor resistance mutations. Figure 2 shows detailed drug resistance site information.\u003c/p\u003e\n \u003cp\u003eAmong 77 patients monitored after treatment failure, 58 (75.32%) achieved virological suppression (HIV-RNA\u0026thinsp;\u0026lt;\u0026thinsp;50 copies/ml) by December 2024. Sixteen (27.59%) of these patients continued their initial regimen, 14 (24.14%) modified their regimen based on drug resistance reports, and 28 (48.28%) adjusted their regimen empirically. Notably, 33 of the 58 patients (56.90%) remained on a second-generation integrase inhibitor regimen. Additionally, 8 patients (10.39%) had HIV-RNA levels between 50 and 200 copies/ml, and 11 (14.29%) had levels exceeding 200 copies/ml. Figure \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e shows the management and treatment outcomes of 77 patients.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e Second-generation INSTIs, such as DTG and BIC, are endorsed as first-line treatments in all HIV guidelines [4]. This study analyzed data from 1,215 HIV-positive patients in Chongqing. Among these patients, 63.46% had baseline HIV-RNA levels exceeding 100,000 copies/ml, 34.90% exceeded 500,000 copies/ml, 67.41% had baseline CD4 counts below 200, and 42.06% were over 50 years old. This study addresses the gap in real-world efficacy data for second-generation INSTIs, particularly in the contexts of late detection, delayed treatment, and the absence of baseline resistance testing, offering a comprehensive view of their effectiveness in practice.\u003c/p\u003e\u003cp\u003eThis study is the first to evaluate the efficacy of second-generation INSTIs in newly infected HIV patients in Southwest China and to directly investigate the causes of VF in this region. The VF rate at one year with this regimen was 6.34% (77/1215), which was significantly lower than the 10.3% observed with nonintegrase inhibitor regimens, such as NNRTI-based ART (viral load\u0026thinsp;\u0026ge;\u0026thinsp;200 copies/mL) [11]. The B/F/TAF regimen outperformed bDRV-based regimens in achieving virological suppression, regardless of whether the criterion was HIV RNA\u0026thinsp;\u0026lt;\u0026thinsp;50 copies/mL or \u0026lt;\u0026thinsp;200 copies/mL [12]. However, compared with RCTs, there remains a substantial gap in efficacy, with an effective rate less than 95% within one year, which falls short of the World Health Organization's (WHO) target. Thus, in populations at high risk of treatment failure, it is crucial to identify risk factors and implement intervention strategies to increase the success rate of antiviral therapy.\u003c/p\u003e\u003cp\u003eTo elucidate the characteristics of high-risk populations for treatment failure, both univariate and multivariate analyses were conducted. Univariate analysis identified factors contributing to VF as baseline HIV-RNA\u0026thinsp;\u0026gt;\u0026thinsp;500,000 copies/mL, baseline CD4\u0026thinsp;+\u0026thinsp;T lymphocytes\u0026thinsp;\u0026lt;\u0026thinsp;200/\u0026micro;L, concurrent opportunistic infections, poor treatment adherence, and LLV. Independent risk factors included baseline CD4\u0026thinsp;+\u0026thinsp;T lymphocytes\u0026thinsp;\u0026lt;\u0026thinsp;200/\u0026micro;L, poor adherence, and LLV. Patients with baseline CD4\u0026thinsp;+\u0026thinsp;T lymphocytes\u0026thinsp;\u0026lt;\u0026thinsp;200/\u0026micro;L and opportunistic infections are in advanced AIDS stages. In addition to ART, these patients may require additional medications, such as antituberculosis drugs, antifungal drugs, and corticosteroids, which can interact with ART, affecting drug concentrations and leading to treatment failure [13]. Advanced AIDS patients are also susceptible to cancers, particularly intestinal cancer, which can cause treatment failure and induce HIV resistance, even with good adherence. Although the dual regimen's efficacy and safety are well established, this study did not find an increased VF risk associated with it, despite potential confounding from patients with high baseline viral loads not included in the dual treatment arm.\u003c/p\u003e\u003cp\u003eThis study demonstrated that LLV increases the risk of VF, which aligns with previous findings. LLV perpetuates viral replication, replenishing latent reservoirs that sustain the presence of the virus [14\u0026ndash;16]. LLV was notably prevalent among patients with delayed detection and poor adherence to treatment [17]. Despite the advantages of second-generation INSTIs, including reduced tablet burden and minimal side effects, 17.37% of patients in this study exhibited LLV. Prompt attention should be given to the occurrence of LLV. The etiology of LLV remains uncertain, although prior research suggests that it may result from intermittent proviral release with limited replication capacity. Additionally, factors such as drug interactions and poor adherence can impair pharmacokinetics, diminishing antiviral efficacy and inducing LLV. Enhanced monitoring of HIV RNA or DNA drug resistance and blood drug concentrations is recommended, with timely interventions as needed. There is no consensus on altering ART regimens for unexplained persistent LLV, so this warrants further investigation.\u003c/p\u003e\u003cp\u003eAchieving virological success requires both selecting the appropriate drug and ensuring medication adherence. Even with regimens featuring high resistance gene barriers, such as those with second-generation INSTIs, poor adherence significantly increases the risk of treatment failure. In this study, 8.07% of patients exhibited poor adherence, and among the 77 patients who experienced VF, 52% had poor compliance. In China, only 68.3% of patients achieved\u0026thinsp;\u0026ge;\u0026thinsp;95% adherence by the third month of ART, whereas in the United States, adherence ranged from 67.7\u0026ndash;83.5% [18\u0026ndash;19]. Poor adherence poses a major challenge to AIDS prevention and control efforts. Enhancing educational outreach, improving patient awareness and initiatives for standardized medication use, and establishing a comprehensive \"prevention-treatment-care\" model through multidepartmental services are essential to improving adherence.\u003c/p\u003e\u003cp\u003e The 2024 guidelines from China emphasize the importance of closely monitoring HIV RNA in newly infected individuals to promptly identify VF, analyze its causes, and adjust treatment strategies accordingly [20]. This approach ensures effective follow-up after timely detection of HIV resistance. In this study, 77 patients experienced treatment failure; however, only 23 underwent HIV drug resistance testing due to economic constraints; this underscores the need for increased public health investment and enhanced laboratory capabilities to ensure comprehensive drug resistance testing for all patients experiencing treatment failure. Among the 23 strains tested, 16 (69.57%) exhibited drug resistance mutations, with a 52.17% incidence of nucleoside drug resistance and a 13.04% incidence of integrase resistance, confirming the greater resistance barrier of second-generation INSTIs. Over 85% of patients with treatment failure did not develop mutations at resistance sites for these drugs, allowing their continued use in subsequent ART regimens. A follow-up of the 77 VF patients revealed that 58 achieved successful viral suppression, with 33 continuing to receive anti-HIV therapy incorporating second-generation INSTIs.\u003c/p\u003e\u003cp\u003eThis study has several limitations. First, pretreatment HIV RNA resistance testing to assess potential transmission resistance factors contributing to treatment failure is lacking. Second, the compliance analysis was rudimentary; it identified variations in virologic outcomes among patients with poor compliance but failed to explore the relationship between varying degrees of noncompliance and treatment efficacy. Finally, the study did not specifically analyze the types of opportunistic infections, making it impossible to determine whether different types and sites of these infections affect the success of virological suppression differently.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study significantly advances our understanding of the efficacy of ART regimens incorporating second-generation INSTIs. Despite a high treatment failure rate in Southwest China—attributable to late detection, delayed treatment, a substantial elderly population, high baseline viral loads, and low CD4 counts—the incidence of integrase drug resistance mutations among patients experiencing treatment failure was low. Many patients achieve successful virological suppression through improved compliance education while maintaining their original regimen. This study identified patients with baseline CD4+ T lymphocyte counts less than 200/µL, LLV, and poor treatment adherence as high-risk patients for treatment failure, underscoring the need for targeted early interventions to mitigate this risk.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eVF: virological failure; INSTIs: integrase inhibitors; ART: antiretroviral therapy; LLV: low-level viremia; NNRTIs: nonnucleoside reverse transcriptase inhibitors; RCTs: randomized controlled trials.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the Ethics Committee of Chongqing Public Health Medical Center (2024-017-01-KY). Since the present study was retrospective and all patients' data were analyzed anonymously, the institutional review board waived the requirement for written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003enot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe raw data may be requested from the first author and corresponding author, with administrative permissions of the review board of the Chongqing Public Health Medical Center, first author and corresponding author. All patient data has been de-identified.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe first batch of key public health disciplines (specialties) in Chongqing. Chongqing Science and Health Joint Medical Research Project (2024MSXM117)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy design: ML and HL. Collection and interpretation of data: KH and YMZ, XQH, QC, XD, JQ and MJL. Statistical analyses and drafting of manuscript: KH and YMZ. Review of manuscript for important intellectual content: HLand ML.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors have read and approved the manuscript\u003c/p\u003e"},{"header":"Reference","content":"\u003col\u003e\n\u003cli\u003ePyngottu A, Scherrer AU, Kouyos R, Huber M, Hirsch H, Perreau M, et al. Swiss HIV Cohort Study. Predictors of virological failure and time to viral suppression of first-line integrase inhibitor-based antiretroviral treatment. Clin Infect Dis 2021; 73(7): e2134\u0026ndash;e2141. https://doi.org/10.1093/cid/ciaa1614.\u003c/li\u003e\n\u003cli\u003eMulisa D, Tolossa T, Bayisa L, Abera T, Wakuma B. First-line virologic-based ART treatment failure and associated factors among adult HIV positives in Southwest Shoa, Central Ethiopia. J Int Assoc Provid AIDS Care 2022; 21: 23259582221111080. https://doi.org/10.1177/23259582221111080 \u003c/li\u003e\n\u003cli\u003eSchuettfort G, Boekenkamp L, Cabello A, Cotter AG, De Leuw P, Doctor J, et al. Antiretroviral treatment outcomes among late HIV presenters initiating treatment with integrase inhibitors or protease inhibitors. HIV Med 2021; 22(1): 47\u0026ndash;53. https://doi.org/10.1111/hiv.12962 \u003c/li\u003e\n\u003cli\u003eU.S. Department of Health and Human Services. Guidelines for the use of antiretroviral agents in adults and adolescents living with HIV. September 2024. \u003c/li\u003e\n\u003cli\u003eSax PE, Arribas JR, Orkin C, Lazzarin A, Pozniak A, DeJesus E.,et al. Bictegravir/emtricitabine/tenofovir alafenamide as initial treatment for HIV-1: five-year follow-up from two randomized trials. E Clinical Medicine. 2023; 59:101991. https://doi.org/10.1016/j.eclinm.2023.101991.\u003c/li\u003e\n\u003cli\u003eJarrin I, Suarez-Garcia I, Moreno C, Tasias M, Del Romero J, Palacios R, et al.; Cohort of the Spanish HIV/AIDS Research Network (CoRIS). Durability of first-line antiretroviral regimens in the era of integrase inhibitors: a cohort of HIV-positive individuals in Spain, 2014-2015. Antivir Ther 2019; 24(3): 167\u0026ndash;175. https://doi.org/10.3851/IMP3297.\u003c/li\u003e\n\u003cli\u003eAlejos B, Su\u0026aacute;rez-Garc\u0026iacute;a I, Rava M, Bautista-Hern\u0026aacute;ndez A, Gutierrez F, Dalmau D, et al.; CoRIS. Effectiveness and safety of first-line antiretroviral regimens in clinical practice: a multicentre cohort study. J Antimicrob Chemother 2020; 75(10): 3004\u0026ndash;3014. https://doi.org/10.1093/jac/dkaa246.\u003c/li\u003e\n\u003cli\u003eAmor-Garc\u0026iacute;a M\u0026Aacute;, Rodr\u0026iacute;guez-Gonz\u0026aacute;lez CG, Chamorro-de-Vega E, Herranz-Alonso A, Sanjurjo-S\u0026aacute;ez M. Dolutegravir-based dual therapies in HIV pretreated patients: a real-life study in Madrid. Ann Pharmacother 2022; 56(4): 401\u0026ndash;411. doi: 10.1177/10600280211038504.\u003c/li\u003e\n\u003cli\u003eYue Q, Liu YF, Li J, Zang CP. [Title in Chinese]. Zhonghua Yu Fang Yi Xue Za Zhi 2018; 52(12): 1248\u0026ndash;1253. https://doi.org/10.3760/cma.j.issn.0253-9624.2018.12.011\u003c/li\u003e\n\u003cli\u003eWensing AM, Calvez V, Ceccherini-Silberstein F, Charpentier C, G\u0026uuml;nthard HF, Paredes R, et al. 2019 update of the drug resistance mutations in HIV-1. Top Antivir Med. 2019;27(3):111-121.\u003c/li\u003e\n\u003cli\u003eChen S, Han Y, Song XJ, et al. Very high baseline HIV viremia impairs efficacy of non-nucleoside reverse transcriptase inhibitor-based ART: a long-term observation in treatment-na\u0026iuml;ve patients. Infect Dis Poverty 2020; 9(1): 75. https://doi.org/10.1186/s40249-020-00700-8 \u003c/li\u003e\n\u003cli\u003eMounzer K, Brunet L, Fusco JS, et al. Advanced HIV infection in treatment-na\u0026iuml;ve individuals: effectiveness and persistence of recommended 3-drug regimens. Open Forum Infect Dis 2022; 9(3): ofac018. https://doi.org/10.1093/ofid/ofac018\u003c/li\u003e\n\u003cli\u003eKumar S, Rao PS, Earla R, Kumar A. Drug-drug interactions between anti-retroviral therapies and drugs of abuse in HIV systems. Expert Opin Drug Metab Toxicol 2015; 11(3): 343\u0026ndash;355. https://doi.org/10.1517/17425255.2015.996546\u003c/li\u003e\n\u003cli\u003eJoya C, Won SH, Schofield C, et al. Persistent low-level viremia while on antiretroviral therapy is an independent risk factor for virologic failure. Clin Infect Dis 2019; 69(12): 2145\u0026ndash;2152. https://doi.org/10.1093/cid/ciz129\u003c/li\u003e\n\u003cli\u003eZhang T, Ding H, An M, et al. Factors associated with high-risk low-level viremia leading to virologic failure: 16-year retrospective study of a Chinese antiretroviral therapy cohort. BMC Infect Dis 2020; 20(1): 147. https://doi.org/10.1186/s12879-020-4837-y\u003c/li\u003e\n\u003cli\u003eMesic A, Spina A, Mar HT, et al. Predictors of virological failure among people living with HIV receiving first line antiretroviral treatment in Myanmar: retrospective cohort analysis. AIDS Res Ther 2021; 18(1): 16. https://doi.org/10.1186/s12981-021-00336-0 \u003c/li\u003e\n\u003cli\u003eHosmane NN, Kwon KJ, Bruner KM, et al. Proliferation of latently infected CD4+ T cells carrying replication-competent HIV-1: Potential role in latent reservoir dynamics. J Exp Med 2017; 214(4): 959\u0026ndash;972. https://doi.org/10.1084/jem.20170193 \u003c/li\u003e\n\u003cli\u003eWang YY, Jin Y, Chen C, et al. Meta-analysis of adherence to highly active antiretroviral therapy in patients with HIV infection in China. AIDS Care 2019; 31(8): 913\u0026ndash;922. https://doi.org/10.1080/09540121.2018.1554238\u003c/li\u003e\n\u003cli\u003eMcComsey GA, Lingohr-Smith M, Rogers R, Lin J, Donga P. Real-world adherence to antiretroviral therapy among HIV-1 patients across the United States. Adv Ther 2021; 38(9): 4961\u0026ndash;4974. https://doi.org/10.1007/s12325-021-01883-8\u003c/li\u003e\n\u003cli\u003eWu, J., Lu, A. D., Zhang, L. P., Zuo, Y. X., \u0026amp; Jia, Y. P. (2019). \u003cem\u003eZhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi\u003c/em\u003e, \u003cem\u003e40\u003c/em\u003e(1), 52\u0026ndash;57. https://doi.org/10.3760/cma.j.issn.0253-2727.2019.01.010\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"AIDS, second-generation integrase inhibitors, virologic failure","lastPublishedDoi":"10.21203/rs.3.rs-6577561/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6577561/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To assess the virological failure (VF) rate and determinants in treatment-naïve HIV patients using regimens with second-generation integrase inhibitors (INSTIs) in regions characterized by delayed diagnosis and advanced AIDS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eWe collected data from HIV-naïve patients who began antiretroviral therapy (ART) at Chongqing Public Health Medical Center between January 2018 and January 2023. Patients receiving second-generation INSTIs in their ART regimen were selected for study. Demographic information, clinical comorbidities, and laboratory test results before and after treatment, along with treatment compliance data, were gathered to calculate the VF rate. Independent risk factors for VF were analyzed via univariate and multivariate methods.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA total of 1,215 treatment-naïve HIV-infected individuals were screened for ART via a second-generation INSTIs regimen. Among them, 819 (67.41%) had baseline CD4+ T lymphocyte counts less than 200/µL, and 424 (34.90%) had baseline HIV RNA levels exceeding 500,000 copies/ml. The VF rate was 6.34% (77/1,215) at 48 weeks posttreatment. Univariate analysis revealed that baseline CD4+ T lymphocytes \u0026lt;200/µL, baseline HIV RNA \u0026gt;500,000 copies/ml, coinfection with opportunistic infections, occurrence of low-level viremia (LLV), and poor drug adherence were risk factors for VF. Multivariate analysis confirmed that a baseline CD4+ T lymphocyte count \u0026lt;200/µL, LLV, and poor drug adherence were independent risk factors for VF. Among the 77 patients who experienced VF, 23 underwent HIV gene resistance testing, revealing integrase drug resistance mutations in 3 patients (13.04%). By December 2024, 58 of the 77 VF patients achieved successful virologic suppression (16 maintained the original regimen), 8 had HIV RNA levels between 50 and 200 copies/ml, and 11 had levels \u0026gt;200 copies/ml.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eIn real-world scenarios where HIV is detected and treated late, second-generation INSTIs exhibit a high rate of VF However, the incidence of integrase drug resistance mutations among patients experiencing VF is low. Many patients achieve successful virologic suppression through enhanced adherence education while continuing their original regimen. Patients with a baseline CD4+ T lymphocyte count less than 200/µL, LLV, and poor drug adherence are at an elevated risk for treatment failure and warrant particular attention.\u003c/p\u003e","manuscriptTitle":"Analysis of the Virological Failure Rates and Influencing Factors of ART Regimens Containing Integrase Inhibitors: A Retrospective Analysis from the Real World in Chongqing","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-07 04:16:19","doi":"10.21203/rs.3.rs-6577561/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b3356e00-c91d-41f6-9afd-ee5af8e42ce0","owner":[],"postedDate":"August 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-08T07:43:43+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-07 04:16:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6577561","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6577561","identity":"rs-6577561","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}