{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:00:44Z","timestamp":1786366844137,"version":"build-2736575974"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2023,4,18]],"date-time":"2023-04-18T00:00:00Z","timestamp":1681776000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100004417","name":"Global Fund","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004417","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Tuberculosis and Malaria"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>We conducted a nationwide cross-sectional study to estimate pretreatment drug resistance (PDR) prevalence in adults initiating ART in Sri Lanka following the WHO\u2019s recommendations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>HIV drug resistance was determined on dried blood spots (DBSs) using population-based sequencing of the protease and reverse transcriptase genes and interpretation was based on Stanford HIVdb v9.0. Analyses were weighted to adjust for multistage sampling and genotypic failure rate. We used logistic regression to assess differences between groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Overall, in 10% (15 of 150) of patients initiating ART, HIV drug resistance mutations were detected. The prevalence of resistance to NNRTI drugs efavirenz\/nevirapine was 8.4% (95% CI 4.6\u201315.0) but differed among those reporting having prior antiretroviral (ARV) exposure (24.4%, 95% CI 13.8\u201339.5) compared with 4.6% (95% CI 1.6\u201312.8) for those reporting as being ARV naive (OR 4.6, 95% CI 1.3\u201316.6, P\u200a=\u200a0.021). PDR to efavirenz\/nevirapine was also nearly twice as high among women (14.1%, 95% CI 6.1\u201329.4) compared with men (7.0%, 95% CI 3.1\u201314.7) (P\u200a=\u200a0.340) and three times high among heterosexuals (10.4%, 95% CI 2.4\u201335.4) compared with MSM (3.8%, 95% CI 1.1\u201312.7) (P\u200a=\u200a0.028). NRTI PDR prevalence was 3.8% (95% CI 1.1\u201312.1) and no PI PDR was observed in the study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>A high prevalence of efavirenz\/nevirapine PDR was reported, especially in patients with prior ARV exposure, in women and those reporting being heterosexual. These findings highlight the need to fast-track the transition to the WHO-recommended dolutegravir-based first-line ART.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jac\/dkad110","type":"journal-article","created":{"date-parts":[[2023,4,18]],"date-time":"2023-04-18T17:45:42Z","timestamp":1681839942000},"page":"1476-1479","source":"Crossref","is-referenced-by-count":1,"title":["Prevalence of pretreatment drug resistance in persons initiating and reinitiating antiretroviral therapy in Sri Lanka: results from a national representative survey"],"prefix":"10.1093","volume":"78","author":[{"given":"J","family":"Elwitigala","sequence":"first","affiliation":[{"name":"National STD\/AIDS Control Programme, Ministry of Health , Colombo , Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"Rajapaksa","sequence":"additional","affiliation":[{"name":"National STD\/AIDS Control Programme, Ministry of Health , Colombo , Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0155-7391","authenticated-orcid":false,"given":"S C","family":"Inzaule","sequence":"additional","affiliation":[{"name":"Amsterdam Institute for Global Health and Development, and Department of Global Health, Amsterdam UMC, University of Amsterdam , Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K A M","family":"Ariyaratne","sequence":"additional","affiliation":[{"name":"National STD\/AIDS Control Programme, Ministry of Health , Colombo , Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Jayasena","sequence":"additional","affiliation":[{"name":"National STD\/AIDS Control Programme, Ministry of Health , Colombo , Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Kurle","sequence":"additional","affiliation":[{"name":"HIV Drug Resistance Laboratory, National AIDS Research Institute , Pune , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Patil","sequence":"additional","affiliation":[{"name":"HIV Drug Resistance Laboratory, National AIDS Research Institute , Pune , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Kale","sequence":"additional","affiliation":[{"name":"HIV Drug Resistance Laboratory, National AIDS Research Institute , Pune , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"Siriwardna","sequence":"additional","affiliation":[{"name":"National STD\/AIDS Control Programme, Ministry of Health , Colombo , Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G","family":"Samaraweera","sequence":"additional","affiliation":[{"name":"National STD\/AIDS Control Programme, Ministry of Health , Colombo , Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H","family":"Perera","sequence":"additional","affiliation":[{"name":"National STD\/AIDS Control Programme, Ministry of Health , Colombo , Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Jayakody","sequence":"additional","affiliation":[{"name":"National STD\/AIDS Control Programme, Ministry of Health , Colombo , Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,4,18]]},"reference":[{"key":"2023060100350480900_dkad110-B1","author":"UNAIDS","year":"2021"},{"key":"2023060100350480900_dkad110-B2","author":"UNAIDS","year":"2022"},{"key":"2023060100350480900_dkad110-B3","author":"WHO","year":"2021"},{"key":"2023060100350480900_dkad110-B4","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/S1473-3099(11)70255-9","article-title":"Effect of pretreatment HIV-1 drug resistance on immunological, virological, and drug-resistance outcomes of first-line antiretroviral treatment in sub-Saharan Africa: a multicentre cohort study","volume":"12","author":"Hamers","year":"2012","journal-title":"Lancet Infect Dis"},{"key":"2023060100350480900_dkad110-B5","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1093\/infdis\/jix089","article-title":"Impact of HIV drug resistance on HIV\/AIDS-associated mortality, new infections, and antiretroviral therapy program costs in sub\u2013Saharan Africa","volume":"215","author":"Phillips","year":"2017","journal-title":"J Infect Dis"},{"key":"2023060100350480900_dkad110-B6","author":"WHO","year":"2019"},{"key":"2023060100350480900_dkad110-B7","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/S2055-6640(20)30311-3","article-title":"Is pricing of dolutegravir equitable? A comparative analysis of price and country income level in 52 countries","volume":"4","author":"Sim","year":"2018","journal-title":"J Virus Erad"},{"key":"2023060100350480900_dkad110-B8","author":"UNAIDS","year":"2022"},{"key":"2023060100350480900_dkad110-B9","author":"WHO","year":"2014"},{"key":"2023060100350480900_dkad110-B10","author":"Ministry of Health Sri Lanka, National STD\/AIDS Control Program","year":"2020"},{"key":"2023060100350480900_dkad110-B11","author":"WHO","year":"2021"},{"key":"2023060100350480900_dkad110-B12","doi-asserted-by":"crossref","first-page":"15751","DOI":"10.1038\/s41598-018-33538-0","article-title":"Previous antiretroviral drug use compromises standard first-line HIV therapy and is mediated through drug-resistance","volume":"8","author":"Inzaule","year":"2018","journal-title":"Sci Rep"},{"key":"2023060100350480900_dkad110-B13","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1186\/s12913-017-2172-9","article-title":"Patients who restart antiretroviral medication after interruption remain at high risk of unfavorable outcomes in Ethiopia","volume":"17","author":"Teklu","year":"2017","journal-title":"BMC Health Serv Res"},{"key":"2023060100350480900_dkad110-B14","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25656","article-title":"Prevalence of pretreatment HIV drug resistance in key populations: a systematic review and meta-analysis","volume":"23","author":"Macdonald","year":"2020","journal-title":"J Int AIDS Soc"},{"key":"2023060100350480900_dkad110-B15","author":"FPA Sri Lanka"},{"key":"2023060100350480900_dkad110-B16","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1097\/QAD.0000000000001801","article-title":"Suboptimal immune recovery during antiretroviral therapy with sustained HIV suppression in sub-Saharan Africa","volume":"32","author":"Kroeze","year":"2018","journal-title":"AIDS"},{"key":"2023060100350480900_dkad110-B17","doi-asserted-by":"crossref","first-page":"18651","DOI":"10.7448\/IAS.17.1.18651","article-title":"Poor CD4 recovery and risk of subsequent progression to AIDS or death despite viral suppression in a South African cohort","volume":"17","author":"Takuva","year":"2014","journal-title":"J Int AIDS Soc"},{"key":"2023060100350480900_dkad110-B18","author":"WHO","year":"2017"}],"container-title":["Journal of Antimicrobial Chemotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jac\/article-pdf\/78\/6\/1476\/50488841\/dkad110.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jac\/article-pdf\/78\/6\/1476\/50488841\/dkad110.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T00:38:32Z","timestamp":1685579912000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jac\/article\/78\/6\/1476\/7127728"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,18]]},"references-count":18,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,4,18]]},"published-print":{"date-parts":[[2023,6,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jac\/dkad110","relation":{},"ISSN":["0305-7453","1460-2091"],"issn-type":[{"value":"0305-7453","type":"print"},{"value":"1460-2091","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,6]]},"published":{"date-parts":[[2023,4,18]]}}}