Characterization of human immunodeficiency virus drug-resistance mutations among individuals with low-level-viremia in low-income and middle-income countries: A meta-analysis
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, Habib Omari Ramadhani
Ibrahim Ahmed El-Imam, Department of Epidemiology, University of Maryland School of Medicine, Baltimore, MD 21201, United States
Upendo Kayeke Chenya, Department of Prevention and Treatment, Drug Control and Enforcement Authority, Dar es Salaam 15103, Tanzania
Jackline Vicent Mbishi, Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam 15103, Tanzania
Timothy Antipas Peter, Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University, Moshi 25116, Kilimanjaro, Tanzania
Beatrice Kelvin Mpimo, Department of Research, Lincoln University, Oakland, CA 94612, United States
Nicaise Ndembi, Department of Research, International Vaccine Institute IVI Africa Regional Office, Kigali KN78, Rwanda
Hafidha Mhando Bakari, Department of Literature, Communication and Publishing, University of Dar es Salaam, Dar es Salaam 35091, Tanzania
Mariam Salim Mbwana, Department of Medicine, Primary Health Care Institute, Iringa 51108, Tanzania
Hassan Fredrick Fussi, Department of Medicine, District Hospital, Dar es Salaam 35091, Tanzania
Haji Mbwana Ally, Department of Medicine, Kilimanjaro Christian Medical Center, Moshi 25116, Kilimanjaro, Tanzania
Sanad Wael Dababneh, Department of Medicine, University of Jordan, School of Medicine, Amman 11942, Jordan
Habib Omari Ramadhani, Department of Medicine, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201, United States
Co-first authors: Ibrahim Ahmed El-Imam and Upendo Kayeke Chenya.
Author contributions: El-Imam IA and Chenya UK contributed to writing original draft as co-first authors; El-Imam IA, Mbishi JV, Peter TA, Fussi HF, and Ramadhani HO contributed to methodology; El-Imam IA, Bakari HM, Mbwana MS, Ally HM, Dababneh SW and Ramadhani HO contributed to data curation; Chenya UK, Bakari HM, and Ramadhani HO contributed to conceptualization; Chenya UK, Fussi HF, and Ramadhani HO contributed to validation; Mbishi JV, Peter TA, and Ramadhani HO contributed to formal analysis; Peter TA, Mpimo BK, Bakari HM, and Dababneh SW contributed to visualization; all authors reviewed this manuscript, provided feedback, and approved the manuscript in its final form.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
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
Received: September 17, 2025
Revised: October 11, 2025
Accepted: December 24, 2025
Published online: March 25, 2026
Processing time: 177 Days and 6.7 Hours
