{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T23:36:30Z","timestamp":1783121790534,"version":"3.54.6"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Blood Borne and Sexually Transmitted Infections"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Integrase strand transfer inhibitors (INSTIs) are the mainstay of antiretroviral therapy (ART) globally. Virological breakthrough is uncommon but often manifests as low-level viremia, and only 50% of cases have identified drug resistance mutations in the integrase gene. Nonintegrase mutations in the Gag-nucleocapsid protein (NC), envelope glycoprotein (Env), and 3\u2032 polypurine tract (3\u2032PPT) have been identified in vitro.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Between 2015 and 2021, human immunodeficiency virus type 1 (HIV-1) whole genome sequencing was performed on samples from people with recently acquired HIV-1 in the United Kingdom. Sequences were linked to demographic and clinical data within the UK Health Security Agency's HIV and AIDS Reporting System. The relationship between nonintegrase enzyme mutations and virological outcomes was assessed. Of 1106 participants, 375 (34%) started an INSTI-based regimen. Of these, 337 (90%) were men and 196 (52%) were living with subtype B. The median age was 33 years and number of viral loads within 24 months of starting ART was 4.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, Env Y61H (33 [10%]), A539V (16 [5.0%]), 3\u2032PPT c9053t (17 [5.0%]), and NC N8S (16 [4.8%]) were the most prevalent nonintegrase enzyme mutations. Univariable and multivariable Cox regression did not identify significant associations between the presence of these mutations individually and time to viral suppression, or to viral blip. Interestingly, accessory INSTI mutations were found significantly more frequently in people whose virus also harbored the Env mutation A539V (P = .002).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Several nonintegrase mutations were prevalent, but we found no evidence of an impact upon virological outcomes within treatment-naive individuals on INSTI-based regimens who had recently acquired HIV.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/infdis\/jiaf500","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T11:44:22Z","timestamp":1758627862000},"page":"49-58","source":"Crossref","is-referenced-by-count":1,"title":["Real-world Prevalence of Nonintegrase INSTI Resistance-Associated Mutations and Virological Outcomes in People Who Have Recently Acquired HIV-1 in the United Kingdom"],"prefix":"10.1093","volume":"233","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3239-7714","authenticated-orcid":false,"given":"Christine","family":"Kelly","sequence":"first","affiliation":[{"name":"Virus Reference Department, UK Health Security Agency , Colindale ,","place":["United Kingdom"]},{"name":"Centre for Experimental Pathogen Host Research, University College Dublin , Dublin ,","place":["Ireland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4102-8662","authenticated-orcid":false,"given":"James S","family":"Lester","sequence":"additional","affiliation":[{"name":"Virus Reference Department, UK Health Security Agency , Colindale ,","place":["United Kingdom"]},{"name":"Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7186-2482","authenticated-orcid":false,"given":"Daniel","family":"Bradshaw","sequence":"additional","affiliation":[{"name":"Virus Reference Department, UK Health Security Agency , Colindale ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8458-9662","authenticated-orcid":false,"given":"David F","family":"Bibby","sequence":"additional","affiliation":[{"name":"Virus Reference Department, UK Health Security Agency , Colindale ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hodan","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Virus Reference Department, UK Health Security Agency , Colindale ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6331-255X","authenticated-orcid":false,"given":"Gary","family":"Murphy","sequence":"additional","affiliation":[{"name":"Virus Reference Department, UK Health Security Agency , Colindale ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6490-6739","authenticated-orcid":false,"given":"Alison","family":"Brown","sequence":"additional","affiliation":[{"name":"Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5173-2760","authenticated-orcid":false,"given":"Caroline","family":"Sabin","sequence":"additional","affiliation":[{"name":"Institute for Global Health, University College London , London ,","place":["United Kingdom"]},{"name":"National Institute for Health and Care Research Health Protection Research Unit in Bloodborne and Sexually Transmitted Infections, University College London , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3670-6588","authenticated-orcid":false,"given":"Anna-Maria","family":"Geretti","sequence":"additional","affiliation":[{"name":"Department of Medicine of Systems, University of Rome Tor Vergata , Rome ,","place":["Italy"]},{"name":"Department of HIV Medicine, Royal Free London NHS Trust (NorthMid) , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0348-9679","authenticated-orcid":false,"given":"Jean L","family":"Mbisa","sequence":"additional","affiliation":[{"name":"Virus Reference Department, UK Health Security Agency , Colindale ,","place":["United Kingdom"]},{"name":"Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency , London ,","place":["United Kingdom"]},{"name":"National Institute for Health and Care Research Health Protection Research Unit in Bloodborne and Sexually Transmitted Infections, University College London , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,9,26]]},"reference":[{"key":"2026031304550606000_jiaf500-B1","volume-title":"Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach","author":"World Health Organization","year":"2021","edition":"1st ed"},{"issue":"Suppl 5","key":"2026031304550606000_jiaf500-B2","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/hiv.13446","article-title":"BHIVA guidelines on antiretroviral treatment for adults living with HIV-1 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