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We evaluated whether the initial third-drug class predicts time to loss of virologic suppression in Colombia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Historical cohort of 609 ART-na\u00efve adults (2016-2020). Outcome: first HIV RNA \u2265200 copies\/mL. We compared NNRTI, PI, and INSTI regimens using adjusted and IPTW-weighted Cox models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Regimens were NNRTI (72%), PI (20%), and INSTI (8%); 19.9% lost suppression. Compared with NNRTI, PIs showed higher but nonsignificant hazards (aHR 1.50, 95% CI 0.98-2.27). For INSTIs, we did not detect significant differences (aHR 1.22, 95% CI 0.64-2.31). Diagnosis-to-ART delays and treatment interruptions were associated with loss of suppression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Treatment continuity and timely initiation predicted sustained suppression better than drug class. Low INSTI usage limits statistical power to detect differences. Structural barriers to continuity may limit the real-world benefit of newer regimens.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259582261436966","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T09:02:07Z","timestamp":1774602127000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Initial Antiretroviral Third-Drug Class and Time to Loss of Virologic Suppression: A Real-World Colombian Cohort Study"],"prefix":"10.1177","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0319-0623","authenticated-orcid":false,"given":"Juan Carlos","family":"Alzate-\u00c1ngel","sequence":"first","affiliation":[{"name":"Universidad de Antioquia"},{"name":"VIHCOL Group, Cali, 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