HIV treatment failure in tertiary care: clinical epidemiology and preliminary mechanistic characterisation

Background: Despite antiretroviral therapy (ART) scale-up in sub-Saharan Africa, treatment failure remains a significant challenge. We characterised virological and immunological outcomes among people living with HIV (PLHIV) attending tertiary care facilities in Nigeria, with exploratory analysis of potential mechanistic factors. Methods: = 35) in pilot subsets. Results: < 0.01). Conclusion: HIV treatment outcomes at Nigerian tertiary facilities fall substantially short of global targets. The high prevalence of discordant immune-virological responses and preliminary evidence of drug resistance and immune activation suggest multiple interacting pathways to treatment failure. Larger mechanistic studies are warranted to inform targeted interventions.