{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T08:15:38Z","timestamp":1768464938496,"version":"3.49.0"},"reference-count":32,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2019,12,20]],"date-time":"2019-12-20T00:00:00Z","timestamp":1576800000000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"President's Emergency Plan for AIDS Relief"},{"name":"Universidad del Valle de Guatemala","award":["GH001285"],"award-info":[{"award-number":["GH001285"]}]},{"name":"Mexican Government"},{"DOI":"10.13039\/501100003141","name":"Consejo Nacional de Ciencia y Tecnolog\u00eda","doi-asserted-by":"crossref","award":["SALUD-2013-01-202475"],"award-info":[{"award-number":["SALUD-2013-01-202475"]}],"id":[{"id":"10.13039\/501100003141","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern AIDS Soc"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>A nationally representative HIV drug resistance (HIVDR) survey in Nicaragua was conducted to estimate the prevalence of pretreatment HIVDR (PDR) among antiretroviral therapy (ART) initiators and acquired HIVDR among people living with HIV (PLHIV) who had received ART for 12\u00a0\u00b1\u00a03\u00a0months (ADR12) and \u226548\u00a0months (ADR48).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A nationwide cross\u2010sectional survey with a two\u2010stage cluster sampling was conducted from March to November 2016. Nineteen of 45 total ART clinics representing &gt;90% of the national cohort of adults on ART were included. ART initiators were defined as PLHIV initiating or reinitiating first\u2010line ART. HIVDR was assessed for protease, reverse transcriptase and integrase Sanger sequences using the Stanford HIVdb algorithm. Viral load (VL) suppression was defined as &lt;1000\u00a0copies\/mL. Results were weighted according to the survey design.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results and discussion<\/jats:title><jats:p>A total of 638 participants were enrolled (PDR: 171; ADR12: 114; ADR48: 353). The proportion of ART initiators with prior exposure to antiretrovirals (ARVs) was 12.3% (95% CI: 5.8% to 24.3%). PDR prevalence to any drug was 23.4% (95% CI: 14.4% to 35.6%), and 19.3% (95% CI: 12.2% to 29.1%) to non\u2010nucleoside reverse transcriptase inhibitors (NNRTI). NNRTI PDR was higher in ART initiators with previous ARV exposure compared with those with no exposure (76.2% vs. 11.0%, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001). Protease inhibitors (PI) and integrase strand transfer inhibitors PDR was not observed. VL suppression rate was 77.8% (95% CI: 67.1% to 85.8%) in ADR12 and 70.3% (95% CI: 66.7% to 73.8%) in ADR48. ADR12 prevalence to any drug among PLHIV without VL suppression was 85.1% (95% CI: 66.1% to 94.4%), 82.4% to NNRTI and 70.2% to nucleoside reverse transcriptase inhibitors (NRTI). ADR48 prevalence to any drug among PLHIV without VL suppression was 75.5% (95% CI: 63.5% to 84.5 %), 70.7% to NNRTI, 59.4% to NRTI and 4.6% to PI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Despite implementation challenges yielding low\u2010precision HIVDR estimates, high rates of NNRTI PDR were observed in Nicaragua, suggesting consideration of non\u2010NNRTI\u2010based first\u2010line regimens for ART initiators. Strengthened HIVDR monitoring, systematic VL testing, and improved ART adherence support are also warranted.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25429","type":"journal-article","created":{"date-parts":[[2019,12,20]],"date-time":"2019-12-20T14:42:56Z","timestamp":1576852976000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["High levels of pretreatment and acquired HIV drug resistance in Nicaragua: results from the first nationally representative survey, 2016"],"prefix":"10.1002","volume":"22","author":[{"given":"Amalia","family":"Gir\u00f3n\u2010Callejas","sequence":"first","affiliation":[{"name":"Universidad del Valle de Guatemala Guatemala City Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Garc\u00eda\u2010Morales","sequence":"additional","affiliation":[{"name":"Centre for Research in Infectious Diseases National Institute of Respiratory Diseases Mexico City Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ricardo","family":"Mendizabal\u2010Burastero","sequence":"additional","affiliation":[{"name":"Universidad del Valle de Guatemala Guatemala City Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matilde","family":"Rom\u00e1n","sequence":"additional","affiliation":[{"name":"Ministry of Health of Nicaragua Managua Nicaragua"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela","family":"Tapia\u2010Trejo","sequence":"additional","affiliation":[{"name":"Centre for Research in Infectious Diseases National Institute of Respiratory Diseases Mexico City Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marissa","family":"P\u00e9rez\u2010Garc\u00eda","sequence":"additional","affiliation":[{"name":"Centre for Research in Infectious Diseases National Institute of Respiratory Diseases Mexico City Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ver\u00f3nica S","family":"Quiroz\u2010Morales","sequence":"additional","affiliation":[{"name":"Centre for Research in Infectious Diseases National Institute of Respiratory Diseases Mexico City Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra I","family":"Ju\u00e1rez","sequence":"additional","affiliation":[{"name":"U.S. Centers for Disease Control and Prevention Guatemala City Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Ravasi","sequence":"additional","affiliation":[{"name":"Pan\u2010American Health Organization Washington DC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos","family":"Vargas","sequence":"additional","affiliation":[{"name":"Universidad del Valle de Guatemala Guatemala City Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ren\u00e9","family":"Guti\u00e9rrez","sequence":"additional","affiliation":[{"name":"Universidad del Valle de Guatemala Managua Nicaragua"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luz","family":"Romero","sequence":"additional","affiliation":[{"name":"Universidad del Valle de Guatemala Managua Nicaragua"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aleyda","family":"Sol\u00f3rzano","sequence":"additional","affiliation":[{"name":"Universidad del Valle de Guatemala Managua Nicaragua"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edgar","family":"Sajquim","sequence":"additional","affiliation":[{"name":"Universidad del Valle de Guatemala Guatemala City Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanny","family":"Northbrook","sequence":"additional","affiliation":[{"name":"U.S. Centers for Disease Control and Prevention Guatemala City Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3371-4248","authenticated-orcid":false,"given":"Santiago","family":"\u00c1vila\u2010R\u00edos","sequence":"additional","affiliation":[{"name":"Centre for Research in Infectious Diseases National Institute of Respiratory Diseases Mexico City Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gustavo","family":"Reyes\u2010Ter\u00e1n","sequence":"additional","affiliation":[{"name":"Centre for Research in Infectious Diseases National Institute of Respiratory Diseases Mexico City Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,12,20]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(17)30702-8"},{"key":"e_1_2_8_3_1","volume-title":"Antiretroviral treatment in the spotlight: a public health analysis in Latin America and the Caribbean 2013","author":"PAHO","year":"2013"},{"key":"e_1_2_8_4_1","unstructured":"MINSA.Gu\u00eda de Terapia Antirretroviral para Personas con VIH. 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