{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T07:49:26Z","timestamp":1790495366323,"version":"4.1.0"},"reference-count":48,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,11,5]],"date-time":"2020-11-05T00:00:00Z","timestamp":1604534400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U01AI069907"],"award-info":[{"award-number":["U01AI069907"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010877","name":"ViiV Healthcare","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010877","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["HIV Medicine"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To assess second\u2010line antiretroviral therapy (ART) virological failure and HIV drug resistance\u2010associated mutations (RAMs), in support of third\u2010line regimen planning in Asia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Adults &gt;\u00a018\u00a0years of age on second\u2010line ART for \u2265\u00a06\u00a0months were eligible. Cross\u2010sectional data on HIV viral load (VL) and genotypic resistance testing were collected or testing was conducted between July 2015 and May 2017 at 12 Asia\u2010Pacific sites. Virological failure (VF) was defined as VL &gt;\u00a01000 copies\/mL with a second VL &gt;\u00a01000 copies\/mL within 3\u20136\u00a0months. FASTA files were submitted to Stanford University HIV Drug Resistance Database and RAMs were compared against the IAS\u2010USA 2019 mutations list. VF risk factors were analysed using logistic regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 1378 patients, 74% were male and 70% acquired HIV through heterosexual exposure. At second\u2010line switch, median [interquartile range (IQR)] age was 37\u00a0(32\u201342) years and median (IQR) CD4 count was 103 (43.5\u2013229.5) cells\/\u00b5L; 93% received regimens with boosted protease inhibitors (PIs). Median duration on second line was 3\u00a0years. Among 101 patients (7%) with VF, CD4 count &gt;\u00a0200 cells\/\u00b5L at switch [odds ratio (OR)\u00a0=\u00a00.36, 95% confidence interval (CI): 0.17\u20130.77 <jats:italic>vs<\/jats:italic>. CD4 \u2264\u00a050) and HIV exposure through male\u2013male sex (OR\u00a0=\u00a00.32, 95% CI: 0.17\u20130.64 <jats:italic>vs<\/jats:italic>. heterosexual) or injecting drug use (OR\u00a0=\u00a00.24, 95% CI: 0.12\u20130.49) were associated with reduced VF. Of 41 (41%) patients with resistance data, 80% had at least one RAM to nonnucleoside reverse transcriptase inhibitors (NNRTIs), 63% to NRTIs, and 35% to PIs. Of those with PI RAMs, 71% had two or more.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There were low proportions with VF and significant RAMs in our cohort, reflecting the durability of current second\u2010line regimens.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hiv.13006","type":"journal-article","created":{"date-parts":[[2020,11,5]],"date-time":"2020-11-05T12:48:08Z","timestamp":1604580488000},"page":"201-211","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Virological failure and HIV drug resistance among adults living with HIV on second\u2010line antiretroviral therapy in the Asia\u2010Pacific"],"prefix":"10.1111","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3183-2451","authenticated-orcid":false,"given":"J","family":"Ross","sequence":"first","affiliation":[{"name":"TREAT Asia\/amfAR \u2013The Foundation for AIDS Research Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4810-0783","authenticated-orcid":false,"given":"A","family":"Jiamsakul","sequence":"additional","affiliation":[{"name":"The Kirby Institute UNSW Sydney Kensington NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N","family":"Kumarasamy","sequence":"additional","affiliation":[{"name":"Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS) VHS\u2010Infectious Diseases Medical Centre VHS Chennai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I","family":"Azwa","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit Department of Medicine Faculty of Medicine University of Malaya Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"TP","family":"Merati","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Udayana University &amp; Sanglah Hospital Bali Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CD","family":"Do","sequence":"additional","affiliation":[{"name":"Bach Mai Hospital Hanoi Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MP","family":"Lee","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Hospital Hong Kong SAR Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"PS","family":"Ly","sequence":"additional","affiliation":[{"name":"National Center for HIV\/AIDS Dermatology &amp; STDs Phnom Penh Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E","family":"Yunihastuti","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Universitas Indonesia \u2010 Dr Cipto Mangunkusumo General Hospital Jakarta Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"KV","family":"Nguyen","sequence":"additional","affiliation":[{"name":"National Hospital for Tropical Diseases Hanoi Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Ditangco","sequence":"additional","affiliation":[{"name":"Research Institute for Tropical Medicine Muntinlupa City Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"OT","family":"Ng","sequence":"additional","affiliation":[{"name":"Tan Tock Seng Hospital Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2775-3315","authenticated-orcid":false,"given":"JY","family":"Choi","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Department of Internal Medicine Yonsei University College of Medicine Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Oka","sequence":"additional","affiliation":[{"name":"National Center for Global Health and Medicine Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AH","family":"Sohn","sequence":"additional","affiliation":[{"name":"TREAT Asia\/amfAR \u2013The Foundation for AIDS Research Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Law","sequence":"additional","affiliation":[{"name":"The Kirby Institute UNSW Sydney Kensington NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,11,5]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"UNAIDS.2018 Global HIV Statistics Fact Sheet.2019."},{"issue":"5","key":"e_1_2_6_3_1","article-title":"Profile of HIV patients on second line antiretroviral therapy: the indian experience","volume":"6","author":"Patrikar S","year":"2015","journal-title":"J AIDS Clin Res"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.3851\/IMP3194"},{"key":"e_1_2_6_5_1","unstructured":"WHO.Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. 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