{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T11:36:09Z","timestamp":1769945769410,"version":"3.49.0"},"reference-count":20,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2022,6,30]],"date-time":"2022-06-30T00:00:00Z","timestamp":1656547200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Medical Virology"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:label\/><jats:p>Human immunodeficiency virus (HIV) drug resistance increases mortality and morbidity and antiretroviral therapy (ART) costs. We describe Paraguay's first nationally representative survey on pretreatment drug resistance (PDR) conducted among persons who initiated or reinitiated ART in 2019. \u200b\u200b\u200b\u200bWe conducted a cross\u2010sectional survey of antiretroviral (ARV) drug resistance in Paraguay in 2019. Participants were sampled at four comprehensive care clinics where 90% of patients with HIV in Paraguay initiate ART. Patients included were adults \u226518 years old who initiated first\u2010line ART or reinitiated the same first\u2010line ART regimen after \u22653 months of discontinuation. Of 208 patients, 93.8% had no prior ART exposure, 3.8% reinitiated the same regimen, 2.4% had unknown prior ART exposure; and 31.3% had a CD4 count &lt;200\u2009cells\/\u00b5l. Mutations associated with resistance were present in 15.4% of patients. Mutations associated with resistance to nonnucleoside reverse transcriptase inhibitors (NNRTI) were present in 13.0% of patients, nucleoside reverse transcriptase inhibitors in 4.3%, and integrase inhibitors in 3.4%. Mutations associated with resistance to tenofovir were present in 1.0% of patients and emtricitabine\/lamivudine in 1.4%. \u200b\u200bNearly one in six patients had PDR in Paraguay's first nationally representative sample. High NNRTI PDR prevalence underscores the need to accelerate the transition to dolutegravir\u2010based first\u2010line ART. The low\u00a0PDR prevalence of tenofovir and emtricitabine is reassuring as these ARVs are part of the World Health Organization\u00a0(WHO)\u2010recommended oral pre\u2010exposure prophylaxis\u00a0regimen. The high proportion of individuals initiating ART at a late disease stage highlights the need to improve treatment linkage strategies and implement WHO rapid ART initiation recommendations.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jmv.27933","type":"journal-article","created":{"date-parts":[[2022,6,15]],"date-time":"2022-06-15T02:02:48Z","timestamp":1655258568000},"page":"5061-5065","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["HIV drug resistance in persons initiating or reinitiating first\u2010line antiretroviral therapy in Paraguay: Results of a National Patient Survey"],"prefix":"10.1002","volume":"94","author":[{"given":"Gloria","family":"Aguilar","sequence":"first","affiliation":[{"name":"National Control Program for HIV\/AIDS\/STI Rep\u00fablica del Paraguay Ministry of Public Health and Social Welfare Asunci\u00f3n Paraguay"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong\u2010Ha M.","family":"Truong","sequence":"additional","affiliation":[{"name":"Department of Medicine, Center for Public Health Research University of California San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Ovelar","sequence":"additional","affiliation":[{"name":"National Control Program for HIV\/AIDS\/STI Rep\u00fablica del Paraguay Ministry of Public Health and Social Welfare Asunci\u00f3n Paraguay"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tania","family":"Samudio","sequence":"additional","affiliation":[{"name":"National Control Program for HIV\/AIDS\/STI Rep\u00fablica del Paraguay Ministry of Public Health and Social Welfare Asunci\u00f3n Paraguay"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gladys","family":"Lopez","sequence":"additional","affiliation":[{"name":"National Control Program for HIV\/AIDS\/STI Rep\u00fablica del Paraguay Ministry of Public Health and Social Welfare Asunci\u00f3n Paraguay"}],"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":"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":"Dulce M.","family":"L\u00f3pez\u2010S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Centre for Research in Infectious Diseases National Institute of Respiratory Diseases Mexico City Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"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":"Amalia","family":"Giron","sequence":"additional","affiliation":[{"name":"Department of Global HIV,\u00a0Hepatitis and STI Programmes World Health Organization Geneva Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonieta R.","family":"De Arias","sequence":"additional","affiliation":[{"name":"Centro para el Desarrollo de la Investigaci\u00f3n Cient\u00edfica Asunci\u00f3n Paraguay"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos","family":"Rios\u2010Gonzalez","sequence":"additional","affiliation":[{"name":"Direccion de Investigacion, Facultad de Ciencias Medicas Universidad Nacional de Caaguaz\u00fa Coronel Oviedo Paraguay"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Willi","family":"McFarland","sequence":"additional","affiliation":[{"name":"Center for Public Health Research San Francisco Department of Public Health San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,6,30]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jix089"},{"key":"e_1_2_10_3_1","unstructured":"World Health Organization. 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