Second-line virologic failure and elevated bilirubin as a potential surrogate marker of ART adherence among people living with HIV in Eastern Uganda
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Date
2026
Journal Title
Journal ISSN
Volume Title
Publisher
Springer Nature
Abstract
Second-line antiretroviral therapy (ART) failure remains a challenge in HIV Programs. We conducted a cross
sectional study among people living with HIV on second-line ART in Eastern Uganda to determine the prevalence
and associated factors of virological failure and to assess elevated serum bilirubin as a surrogate marker of
adherence. The prevalence of virological failure was 7.5%. Elevated bilirubin showed poor sensitivity and specificity
for predicting adherence or virological failure. The findings highlight the need for routine viral load monitoring, as
bilirubin is not a reliable surrogate marker of treatment adherence or virological failure.
Keywords Second-line virological failure, Elevated bilirubin, And adherence
Description
Ethical clearance was obtained from the Mbale Regional Referral Hospital
Research Ethics Committee (MRRH-2022-204). Permission to collect data
was sought from the administration of MRRH and Tororo Hospital. Written
informed consent was obtained from all participants who completed the
questionnaires individually to ensure privacy, confidentiality, and anonymity.
Participation was voluntary, and participants could withdraw from the study at
any time without penalty
Keywords
Citation
Lynnet, S. M., Iramiot, J. S., Nekaka, R., Okware, P., Olwedo, M. A., Epuitai, J., ... & Okia, D. (2026). Second-line virologic failure and elevated bilirubin as a potential surrogate marker of ART adherence among people living with HIV in Eastern Uganda. AIDS Research and Therapy.