{"doi":"10.1111/hiv.13006","title":"Virological failure and HIV drug resistance among adults living with HIV on second‐line antiretroviral therapy in the Asia‐Pacific","abstract":"OBJECTIVES: To assess second-line antiretroviral therapy (ART) virological failure and HIV drug resistance-associated mutations (RAMs), in support of third-line regimen planning in Asia. METHODS: Adults > 18 years of age on second-line ART for ≥ 6 months were eligible. Cross-sectional data on HIV viral load (VL) and genotypic resistance testing were collected or testing was conducted between July 2015 and May 2017 at 12 Asia-Pacific sites. Virological failure (VF) was defined as VL > 1000 copies/mL with a second VL > 1000 copies/mL within 3-6 months. FASTA files were submitted to Stanford University HIV Drug Resistance Database and RAMs were compared against the IAS-USA 2019 mutations list. VF risk factors were analysed using logistic regression. RESULTS: Of 1378 patients, 74% were male and 70% acquired HIV through heterosexual exposure. At second-line switch, median [interquartile range (IQR)] age was 37 (32-42) years and median (IQR) CD4 count was 103 (43.5-229.5) cells/µL; 93% received regimens with boosted protease inhibitors (PIs). Median duration on second line was 3 years. Among 101 patients (7%) with VF, CD4 count > 200 cells/µL at switch [odds ratio (OR) = 0.36, 95% confidence interval (CI): 0.17-0.77 vs. CD4 ≤ 50) and HIV exposure through male-male sex (OR = 0.32, 95% CI: 0.17-0.64 vs. heterosexual) or injecting drug use (OR = 0.24, 95% CI: 0.12-0.49) were associated with reduced VF. Of 41 (41%) patients with resistance data, 80% had at least one RAM to nonnucleoside reverse transcriptase inhibitors (NNRTIs), 63% to NRTIs, and 35% to PIs. Of those with PI RAMs, 71% had two or more. CONCLUSIONS: There were low proportions with VF and significant RAMs in our cohort, reflecting the durability of current second-line regimens.","journal":"HIV Medicine","year":2020,"id":71240,"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":18,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8322,"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":376620,"name":"Awachana Jiamsakul","orcid":"0000-0003-4810-0783","position":1,"is_corresponding":false},{"id":377757,"name":"N Kumarasamy","orcid":null,"position":2,"is_corresponding":false},{"id":376621,"name":"Iskandar Azwa","orcid":"0000-0003-1977-6709","position":3,"is_corresponding":false},{"id":377758,"name":"TP Merati","orcid":null,"position":4,"is_corresponding":false},{"id":377759,"name":"C. G Silva I. D.","orcid":null,"position":5,"is_corresponding":false},{"id":377760,"name":"M. P. Lee","orcid":null,"position":6,"is_corresponding":false},{"id":377761,"name":"PS Ly","orcid":null,"position":7,"is_corresponding":false},{"id":376622,"name":"Evy Yunihastuti","orcid":"0000-0001-6650-0559","position":8,"is_corresponding":false},{"id":377762,"name":"KV Nguyen","orcid":null,"position":9,"is_corresponding":false},{"id":377763,"name":"Rossana Ditangco","orcid":null,"position":10,"is_corresponding":false},{"id":377764,"name":"OT Ng","orcid":null,"position":11,"is_corresponding":false},{"id":369962,"name":"Jun Yong Choi","orcid":"0000-0002-2775-3315","position":12,"is_corresponding":false},{"id":12053,"name":"Shinichi Oka","orcid":"0000-0002-9283-2167","position":13,"is_corresponding":false},{"id":377765,"name":"AH Sohn","orcid":null,"position":14,"is_corresponding":false},{"id":11862,"name":"Matthew Law","orcid":"0000-0002-3540-8837","position":15,"is_corresponding":false},{"id":376619,"name":"Jeremy Ross","orcid":"0000-0003-3183-2451","position":0,"is_corresponding":true}],"reference_count":42,"raw_metadata":null,"created_at":"2026-07-18T21:43:57.004133Z","pmid":"33151020","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":[]}