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The time to virological failure [VF: one measurement of viral load (VL) \u2265\u00a01000 copies\/mL or two \u2265\u00a050 copies\/ml or one VL measurement \u2265\u00a050 copies\/mL followed by treatment change] and to INSTI discontinuation were evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 13\u00a0560 treatments analysed, 4284 were from INSTI\u2010na\u00efve, non\u2010viraemic (IN\u2010NV) individuals, 1465 were from INSTI\u2010na\u00efve, viraemic (IN\u2010V) individuals, 6016 were from INSTI\u2010experienced, non\u2010viraemic (IE\u2010NV) individuals and 1795 were from INSTI\u2010experienced, viraemic (IE\u2010V) individuals. Major INSTI drug resistance mutations (DRMs) were previously detected in 4\/519 (0.8%) IN\u2010NV, 3\/394 (0.8%) IN\u2010V, 7\/1510 (0.5%) IE\u2010NV and 25\/935 (2.7%) IE\u2010V individuals. The 1\u2010year estimated probabilities of VF were 3.1% [95% confidence interval (CI): 2.5\u20133.8] in IN\u2010NV, 18.4% (95% CI: 15.8\u201321.2) in IN\u2010V, 4.2% (95% CI: 3.6\u20134.9) in IE\u2010NV and 23.9% (95% CI: 20.9\u201326.9) in IE\u2010V subjects. The 1\u2010year estimated probabilities of INSTI discontinuation were 12.1% (95% CI: 11.1\u201313.0) in IN\u2010NV, 19.6% (95% CI: 17.5\u201321.6) in IN\u2010V, 10.8% (95% CI: 10.0\u201311.6) in IE\u2010NV and 21.7% (95% CI: 19.7\u201323.5) in IE\u2010V subjects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Both VF and INSTI discontinuation occur at substantial rates in viraemic subjects. 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