Publication Name	World Journal of Virology
Manuscript ID	114375
Country	United States

Category	Infectious Diseases
Manuscript Type	Meta-Analysis
Article Title	Characterization of human immunodeficiency virus drug-resistance mutations among individuals with low-level-viremia in low-income and middle-income countries: A meta-analysis
Manuscript Source	Invited Manuscript
All Author List	Ibrahim Ahmed El-Imam, Upendo Kayeke Chenya, Jackline Vicent Mbishi, Timothy Antipas Peter, Beatrice Kelvin Mpimo, Nicaise Ndembi, Hafidha Mhando Bakari, Mariam Salim Mbwana, Hassan Fredrick Fussi, Haji Mbwana Ally, Sanad Wael Dababneh and Habib Omari Ramadhani
Funding Agency and Grant Number
Corresponding Author	Habib Omari Ramadhani, MD, PhD, Senior Researcher, Department of Medicine, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, MD 21201, United States. homari@ihv.umaryland.edu
Key Words	Low level viremia; Antiretroviral therapy; Drug resistance mutations; Human immunodeficiency virus; Low-income and middle-income countries
Core Tip	Next-generation sequencing enabled successful sequencing and determined drug resistance mutations (DRM) among people with low-level viremia (LLV). Data on the DRM among people with LLV in low-income and middle-income countries (LMIC) is limited and may help achieve human immunodeficiency virus epidemic control. This systematic review and meta-analysis analyzed 7613 people living with human immunodeficiency virus who had LLV from 20 studies conducted in LMIC between 2015 and 2025. Overall, the pooled prevalence of DRM was 50.4%. Pooled prevalence of nucleoside reverse transcriptase inhibitor, non-nucleoside reverse transcriptase inhibitor and protease inhibitor-associated mutations were 44.6%, 50.9% and 5.1% respectively. In LMIC, most patients with LLV have resistance mutations and remain on a failed regimen over an extended period. Because resistance testing is not routinely performed in LMIC, lowering the viral failure threshold may hasten patients switch to effective drugs.
Citation	El-Imam IA, Chenya UK, Mbishi JV, Peter TA, Mpimo BK, Ndembi N, Bakari HM, Mbwana MS, Fussi HF, Ally HM, Dababneh SW, Ramadhani HO. Characterization of human immunodeficiency virus drug-resistance mutations among individuals with low-level-viremia in low-income and middle-income countries: A meta-analysis. World J Virol 2025; In press

Received	2025-09-17 06:48
Peer-Review Started	2025-09-17 06:48
First Decision by Editorial Office Director	2025-09-30 08:46
Return for Revision	2025-09-30 08:46
Revised	2025-10-11 03:46
Publication Fee Transferred
Second Decision by Editor	2025-12-24 02:37
Second Decision by Editor-in-Chief
Final Decision by Editorial Office Director	2025-12-24 06:46
Articles in Press	2025-12-24 06:46
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ISSN	2220-3249 (online)
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