{"doi":"10.1093/ofid/ofaa316","title":"Virological Failure and Acquired Genotypic Resistance Associated With Contemporary Antiretroviral Treatment Regimens","abstract":"BACKGROUND: There are few descriptions of virologic failure (VF) and acquired drug resistance (HIVDR) in large cohorts initiating contemporary antiretroviral therapy (ART). METHODS: We studied all persons with HIV (PWH) in a California clinic population initiating ART between 2010 and 2017. VF was defined as not attaining virologic suppression, discontinuing ART, or virologic rebound prompting change in ART. RESULTS: During the study, 2315 PWH began ART. Six companion drugs were used in 93.3% of regimens: efavirenz, elvitegravir/c, dolutegravir, b-darunavir, rilpivirine, and raltegravir. During a median follow-up of 36 months, 214 (9.2%) PWH experienced VF (2.8 per 100 person-years) and 62 (2.7%) experienced HIVDR (0.8 per 100 person-years). In multivariable analyses, younger age, lower CD4 count, higher virus load, and b-atazanavir were associated with increased VF risk; lower CD4 count, higher virus load, and nevirapine were associated with increased HIVDR risk. Compared with efavirenz, dolutegravir, raltegravir, and b-darunavir were associated with reduced HIVDR risk. Risks of VF and HIVDR were not significantly associated with ART initiation year. Of the 62 PWH with HIVDR, 42 received an non-nucleoside RT inhibitor (NNRTI), 15 an integrase-strand transfer inhibitor (INSTI), and 5 a protease inhibitor (PI). Among those with HIVDR on an NNRTI or first-generation INSTI, 59% acquired dual class resistance and 29% developed tenofovir resistance; those receiving a PI or dolutegravir developed just M184V. CONCLUSIONS: Despite the frequent use of contemporary ART regimens, VF and HIVDR continue to occur. Further efforts are required to improve long-term ART virological responses to prevent the consequences of ongoing HIV-1 replication including virus transmission and HIVDR.","journal":"Open Forum Infectious Diseases","year":2020,"id":78852,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":17,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.943,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":14781,"name":"Dana Clutter","orcid":"0000-0002-0483-7022","position":1,"is_corresponding":false},{"id":396404,"name":"C. Bradley Hare","orcid":null,"position":2,"is_corresponding":false},{"id":409832,"name":"Christophe Toukam Tchakoute","orcid":"0000-0002-8281-044X","position":3,"is_corresponding":false},{"id":65397,"name":"Kristin L. Sainani","orcid":"0000-0003-0614-303X","position":4,"is_corresponding":false},{"id":14775,"name":"W. Jeffrey Fessel","orcid":null,"position":5,"is_corresponding":false},{"id":14777,"name":"Leo B. Hurley","orcid":"0000-0003-2208-3786","position":6,"is_corresponding":false},{"id":410682,"name":"Sally Slome","orcid":null,"position":7,"is_corresponding":false},{"id":226843,"name":"Benjamin A. Pinsky","orcid":"0000-0001-8751-4810","position":8,"is_corresponding":false},{"id":14779,"name":"Michael J. Silverberg","orcid":"0000-0001-9322-1395","position":9,"is_corresponding":false},{"id":14780,"name":"Robert W. Shafer","orcid":"0000-0003-2513-2643","position":10,"is_corresponding":false},{"id":14782,"name":"Soo‐Yon Rhee","orcid":"0000-0002-1231-6542","position":0,"is_corresponding":true}],"reference_count":21,"raw_metadata":null,"created_at":"2026-07-18T21:50:09.793321Z","pmid":"32904894","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}