# Second-line virologic failure and elevated bilirubin as a potential surrogate marker of ART adherence among people living with HIV in Eastern Uganda

## TL;DR

The study found that elevated bilirubin is not a reliable indicator of ART adherence or virologic failure in HIV patients in Uganda.

## Contribution

This study evaluates bilirubin as a potential surrogate marker for ART adherence and virologic failure in a specific regional context.

## Key findings

- The prevalence of virological failure among participants was 7.5%.
- Elevated bilirubin levels showed poor sensitivity and specificity for predicting adherence or virological failure.
- Routine viral load monitoring is emphasized over using bilirubin as a marker.

## 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.