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We therefore systematically investigated the prevalence of PDR and its impact on mortality, attrition and viral suppression amongst patients starting ART.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An observational cohort study was conducted in Southwest China, 2014\u20132022. PDR was analysed using the Stanford HIV Drug Resistance Database. Molecular transmission networks were constructed with HIV-TRACE. Cox and logistic regression evaluated the impact of PDR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Amongst 3478 eligible patients, the overall prevalence of PDR was 6.4%. PDR rates to non-nucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors and protease inhibitors were 4.1%, 1.3% and 1.1%, respectively. The overall mortality and attrition rates were 4.58 and 2.40 per 100 person-years, respectively. Whilst PDR showed no significant association with mortality, it was associated with increased attrition. Compared to those without resistance, the adjusted HR (95% CI) for attrition was 1.67 (1.11\u20132.52) in the overall drug-resistant group, 2.16 (1.36\u20133.43) in the NNRTI-resistant group and 2.09 (1.10\u20133.97) in the efavirenz\/nevirapine-resistant group. Viral suppression was significantly lower in the drug-resistant group [adjusted odds ratio (AOR): 0.46; 95% CI: 0.27\u20130.77], the NNRTI-resistant group (AOR: 0.42; 95% CI: 0.22\u20130.78) and the efavirenz\/nevirapine-resistant group (AOR: 0.41; 95% CI: 0.21\u20130.81).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our study reveals a moderate prevalence of PDR in Southwest China, significantly associated with increased risk of attrition and virologic failure, particularly amongst patients with resistance to efavirenz\/nevirapine. Our findings strongly advocate for routine PDR testing prior to ART initiation to guide optimal first-line treatment strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jac\/dkag073","type":"journal-article","created":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T12:42:21Z","timestamp":1771072941000},"source":"Crossref","is-referenced-by-count":1,"title":["Effect of pretreatment HIV drug resistance on mortality, attrition and viral suppression in patients initiating antiretroviral therapy and genetic transmission network: an observational cohort study in Southwest China"],"prefix":"10.1093","volume":"81","author":[{"given":"Litai","family":"Qin","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University , Nanning 530028 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