{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:02:00Z","timestamp":1787022120584,"version":"build-2736575974"},"reference-count":54,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2023,2,23]],"date-time":"2023-02-23T00:00:00Z","timestamp":1677110400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The HIV Global Fund for Malaria, Tuberculosis and HIV\/AIDS, Tanzania"},{"name":"Swedish International Development Agency"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The emergence of HIV drug resistance mutations (DRMs) is of significant threat to achieving viral suppression (VS) in the quest to achieve global elimination targets. We hereby report virologic outcomes and patterns of acquired DRMs and its associated factors among adolescents and young adults (AYA) from a broader HIV drug resistance surveillance conducted in Tanzania.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Data of AYA was extracted from a cross-sectional study conducted in 36 selected facilities using a two-stage cluster sampling design. Dried blood spot (DBS) samples were collected and samples with a viral load (VL) \u22651000 copies\/mL underwent genotyping for the HIV-1\n                      <jats:italic>pol gene<\/jats:italic>\n                      . Stanford HIV database algorithm predicted acquired DRMs, Fisher\u2019s exact test and multivariable logistic regression assessed factors associated with DRMs and VS, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      We analyzed data of 578 AYA on antiretroviral therapy (ART) for 9\u201315 and \u2265 36 months; among them, 91.5% and 88.2% had VS (VL&lt;1000copies\/mL) at early and late time points, respectively. Genotyping of 64 participants (11.2%) who had VL \u22651000 copies\/ml detected 71.9% of any DRM. Clinically relevant DRMs were K103N, M184V, M41L, T215Y\/F, L210W\/L, K70R, D67N, L89V\/T, G118R, E138K, T66A, T97A and unexpectedly absent K65R. Participants on a protease inhibitor (PI) based regimen were twice as likely to not achieve VS compared to those on integrase strand transfer inhibitors (INSTI). The initial VL done 6 months after ART initiation of \u22651000copies\/mL was the primary factor associated with detecting DRMs (\n                      <jats:italic>p =<\/jats:italic>\n                      .019).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>VS amongst AYA is lower than the third UNAIDs target. Additionally, a high prevalence of ADR and high levels of circulating clinically relevant DRMs may compromise the long-term VS in AYA. Furthermore, the first VL result of \u22651000copies\/ml after ART initiation is a significant risk factor for developing DRMs. Thus, strict VL monitoring for early identification of treatment failure and genotypic testing during any ART switch is recommended to improve treatment outcomes for AYA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0281528","type":"journal-article","created":{"date-parts":[[2023,2,23]],"date-time":"2023-02-23T13:32:06Z","timestamp":1677159126000},"page":"e0281528","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":17,"title":["HIV virologic response, patterns of drug resistance mutations and correlates among adolescents and young adults: A cross-sectional study in Tanzania"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6939-5125","authenticated-orcid":true,"given":"Joan","family":"Rugemalila","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doreen","family":"Kamori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Kunambi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mucho","family":"Mizinduko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amon","family":"Sabasaba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salim","family":"Masoud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Msafiri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabina","family":"Mugusi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Mutagonda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Mlunde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0563-8188","authenticated-orcid":true,"given":"Davis","family":"Amani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erick","family":"Mboya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Macdonald","family":"Mahiti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Ruhago","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremiah","family":"Mushi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veryeh","family":"Sambu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Mgomella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boniface","family":"Jullu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Werner","family":"Maokola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prosper","family":"Njau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Mutayoba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Godfrey","family":"Barabona","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4852-4236","authenticated-orcid":true,"given":"Takamasa","family":"Ueno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8090-3298","authenticated-orcid":true,"given":"Andrea","family":"Pembe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tumaini","family":"Nagu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Sunguya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Said","family":"Aboud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,2,23]]},"reference":[{"issue":"1","key":"pone.0281528.ref001","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-020-09361-6","article-title":"ART use and associated factors among HIV positive caregivers of orphans and vulnerable children in Tanzania.","volume":"20","author":"A Exavery","year":"2020","journal-title":"BMC public health."},{"issue":"7760","key":"pone.0281528.ref002","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1038\/s41586-019-1200-9","article-title":"Mapping HIV prevalence in sub-Saharan Africa between 2000 and 2017","volume":"570","author":"L Dwyer-Lindgren","year":"2019","journal-title":"Nature"},{"issue":"10","key":"pone.0281528.ref003","doi-asserted-by":"crossref","first-page":"e25832","DOI":"10.1002\/jia2.25832","article-title":"Uncovering ART adherence inconsistencies: An assessment of sustained adherence among adolescents in South Africa.","volume":"24","author":"S Zhou","year":"2021","journal-title":"Journal of the International AIDS Society"},{"issue":"11","key":"pone.0281528.ref004","doi-asserted-by":"crossref","first-page":"e1470","DOI":"10.1016\/S2214-109X(19)30404-8","article-title":"HIV incidence rates in adolescent girls and young women in sub-Saharan Africa","volume":"7","author":"SSA Karim","year":"2019","journal-title":"The Lancet Global Health"},{"issue":"3","key":"pone.0281528.ref005","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1097\/COH.0000000000000449","article-title":"The global epidemiology of adolescents living with HIV","volume":"13","author":"AL Slogrove","year":"2018","journal-title":"Current Opinion in HIV and AIDS"},{"issue":"Suppl 1","key":"pone.0281528.ref006","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1186\/s12978-021-01118-7","article-title":"HIV trends and disparities by gender and urban-rural residence among adolescents in sub-Saharan Africa.","volume":"18","author":"R Maulide Cane","year":"2021","journal-title":"Reproductive health."},{"issue":"4","key":"pone.0281528.ref007","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1007\/s00038-020-01350-1","article-title":"HIV vulnerability among adolescent girls and young women: a multi-country latent class analysis approach.","volume":"65","author":"S Mathur","year":"2020","journal-title":"Int J Public Health"},{"key":"pone.0281528.ref008","doi-asserted-by":"crossref","first-page":"4161738","DOI":"10.1155\/2016\/4161738","article-title":"Insights into Adherence among a Cohort of Adolescents Aged 12\u201320 Years in South Africa: Reported Barriers to Antiretroviral Treatment","volume":"2016","author":"M Maskew","year":"2016","journal-title":"AIDS research and treatment"},{"issue":"3","key":"pone.0281528.ref009","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.bjid.2017.02.001","article-title":"Virological suppression in children and adolescents is not influenced by genotyping, but depends on optimal adherence to antiretroviral therapy","volume":"21","author":"JC Abreu","year":"2017","journal-title":"The Brazilian journal of infectious diseases: an official publication of the Brazilian Society of Infectious Diseases"},{"issue":"1","key":"pone.0281528.ref010","doi-asserted-by":"crossref","first-page":"20683","DOI":"10.7448\/IAS.19.1.20683","article-title":"High rates of virological failure and drug resistance in perinatally HIV-1-infected children and adolescents receiving lifelong antiretroviral therapy in routine clinics in Togo.","volume":"19","author":"M Salou","year":"2016","journal-title":"Journal of the International AIDS Society"},{"issue":"11","key":"pone.0281528.ref011","doi-asserted-by":"crossref","first-page":"1729","DOI":"10.1097\/QAD.0000000000002284","article-title":"Drug resistance and optimizing dolutegravir regimens for adolescents and young adults failing antiretroviral therapy","volume":"33","author":"V Kouamou","year":"2019","journal-title":"Aids"},{"issue":"1","key":"pone.0281528.ref012","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1186\/s12978-018-0614-4","article-title":"Risky behaviours and their correlates among adolescents living with HIV in sub-Saharan Africa: a systematic review.","volume":"15","author":"M Zgambo","year":"2018","journal-title":"Reproductive health."},{"key":"pone.0281528.ref013","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.meegid.2016.08.031","article-title":"HIV-1 drug resistance and resistance testing.","volume":"46","author":"DS Clutter","year":"2016","journal-title":"Infection, Genetics and Evolution"},{"issue":"1","key":"pone.0281528.ref014","doi-asserted-by":"crossref","DOI":"10.7448\/IAS.20.1.21858","article-title":"Pregnant adolescents living with HIV: what we know, what we need to know, where we need to go","volume":"20","author":"T Callahan","year":"2017","journal-title":"Journal of the International AIDS Society"},{"issue":"1","key":"pone.0281528.ref015","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1186\/s12981-021-00391-7","article-title":"Determinants of viral suppression among adolescents on antiretroviral treatment in Ehlanzeni district, South Africa: a cross-sectional analysis","volume":"18","author":"EF Okonji","year":"2021","journal-title":"AIDS research and therapy"},{"issue":"6","key":"pone.0281528.ref016","doi-asserted-by":"crossref","first-page":"e1003649","DOI":"10.1371\/journal.pmed.1003649","article-title":"Ending AIDS as a public health threat by 2030: Time to reset targets for 2025.","volume":"18","author":"PR De Lay","year":"2021","journal-title":"PLoS Med."},{"issue":"suppl_9","key":"pone.0281528.ref017","doi-asserted-by":"crossref","first-page":"S801","DOI":"10.1093\/infdis\/jix402","article-title":"The World Health Organization\u2019s Response to Emerging Human Immunodeficiency Virus Drug Resistance and a Call for Global Action","volume":"216","author":"S Bertagnolio","year":"2017","journal-title":"The Journal of Infectious Diseases"},{"issue":"2","key":"pone.0281528.ref018","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/S2055-6640(20)30347-2","article-title":"HIV drug resistance in sub-Saharan Africa: public health questions and the potential role of real-world data and mathematical modelling","volume":"4","author":"R de Waal","year":"2018","journal-title":"Journal of virus eradication"},{"issue":"9","key":"pone.0281528.ref019","doi-asserted-by":"crossref","first-page":"e0232649","DOI":"10.1371\/journal.pone.0232649","article-title":"Patterns of acquired HIV-1 drug resistance mutations and predictors of virological failure in Moshi, Northern Tanzania.","volume":"15","author":"SR Mziray","year":"2020","journal-title":"PloS one"},{"issue":"1","key":"pone.0281528.ref020","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1097\/COH.0b013e32835b7f94","article-title":"Emerging HIV-1 drug resistance after roll-out of antiretroviral therapy in sub-Saharan Africa","volume":"8","author":"RL Hamers","year":"2013","journal-title":"Current Opinion in HIV and AIDS"},{"issue":"10","key":"pone.0281528.ref021","doi-asserted-by":"crossref","first-page":"e588","DOI":"10.1016\/S2352-3018(18)30173-5","article-title":"HIV drug resistance in low-income and middle-income countries","volume":"5","author":"Tobias F. Holmes Hamers RLRdW","year":"2018","journal-title":"The Lancet HIV"},{"issue":"79","key":"pone.0281528.ref022","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1097\/QAI.0000000000001793","article-title":"Antiretroviral drug use and HIV drug resistance among young women in rural South Africa: HPTN 068.","author":"YSM Zhang","year":"2018","journal-title":"J Acquir Immune Defic Syndr."},{"issue":"1","key":"pone.0281528.ref023","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1097\/QAD.0000000000001273","article-title":"Development of HIV drug resistance and therapeutic failure in children and adolescents in rural Tanzania: an emerging public health concern","volume":"31","author":"L Muri","year":"2017","journal-title":"Aids"},{"issue":"Suppl 1","key":"pone.0281528.ref024","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1186\/s12879-019-4339-y","article-title":"Prevalence of HIV-1 drug resistance amongst newly diagnosed HIV-infected infants age 4\u20138 weeks, enrolled in three nationally representative PMTCT effectiveness surveys, South Africa: 2010, 2011\u201312 and 2012\u201313.","volume":"19","author":"GM Hunt","year":"2019","journal-title":"BMC infectious diseases."},{"issue":"6","key":"pone.0281528.ref025","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1089\/aid.2020.0021","article-title":"Circulating HIV-1 Integrase Genotypes in Tanzania: Implication on the Introduction of Integrase Inhibitors-Based Antiretroviral Therapy Regimen","volume":"36","author":"S Masoud","year":"2020","journal-title":"AIDS research and human retroviruses"},{"issue":"Suppl 2","key":"pone.0281528.ref026","doi-asserted-by":"crossref","first-page":"S127","DOI":"10.1097\/QAD.0000000000003082","article-title":"Adherence, resistance, and viral suppression on dolutegravir in sub-Saharan Africa: implications for the TLD era","volume":"35","author":"SM McCluskey","year":"2021","journal-title":"Aids"},{"issue":"12","key":"pone.0281528.ref027","doi-asserted-by":"crossref","first-page":"e054021","DOI":"10.1136\/bmjopen-2021-054021","article-title":"Acquired HIV drug resistance among children and adults receiving antiretroviral therapy in Tanzania: a national representative survey protocol","volume":"11","author":"J Rugemalila","year":"2021","journal-title":"BMJ Open"},{"key":"pone.0281528.ref028","author":"World Health Organization","year":"2015","journal-title":"HIV Drug Resistance Surveillance Guidance"},{"issue":"4","key":"pone.0281528.ref029","doi-asserted-by":"crossref","first-page":"S273","DOI":"10.1093\/cid\/cir982","article-title":"Evaluation of in-house genotyping assay performance using dried blood spot specimens in the Global World Health Organization laboratory network","volume":"54","author":"N Parkin","year":"2012","journal-title":"Clinical infectious diseases: an official publication of the Infectious Diseases Society of America"},{"issue":"2","key":"pone.0281528.ref030","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/S2055-6640(20)30344-7","article-title":"Traversing the cascade: urgent research priorities for implementing the \u2019treat all\u2019 strategy for children and adolescents living with HIV in sub-Saharan Africa.","volume":"4","author":"LA Enane","year":"2018","journal-title":"Journal of virus eradication"},{"issue":"7","key":"pone.0281528.ref031","article-title":"Drug Resistance Among Adolescents and Young Adults with Virologic Failure of First-Line Antiretroviral Therapy and Response to Second-Line Treatment","volume":"36","author":"BV Vinie Kouamou","year":"2020","journal-title":"AIDS research and human retroviruses"},{"key":"pone.0281528.ref032","author":"World Health Organization","year":"2021","journal-title":"HIV Drug Resistance Report"},{"issue":"3","key":"pone.0281528.ref033","doi-asserted-by":"crossref","first-page":"e193","DOI":"10.1016\/S2352-3018(19)30400-X","article-title":"Updated assessment of risks and benefits of dolutegravir versus efavirenz in new antiretroviral treatment initiators in sub-Saharan Africa: modelling to inform treatment guidelines","volume":"7","author":"AN Phillips","year":"2020","journal-title":"The Lancet HIV"},{"issue":"3","key":"pone.0281528.ref034","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/S1473-3099(19)30036-2","article-title":"Dolutegravir versus ritonavir-boosted lopinavir both with dual nucleoside reverse transcriptase inhibitor therapy in adults with HIV-1 infection in whom first-line therapy has failed (DAWNING): an open-label, non-inferiority, phase 3b trial.","volume":"19","author":"M Aboud","year":"2019","journal-title":"The Lancet Infectious diseases"},{"issue":"1","key":"pone.0281528.ref035","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1186\/s12981-021-00408-1","article-title":"Determinants of viral load non-suppression among adolescents in Mbale District, Eastern Rural Uganda.","volume":"18","author":"J Maena","year":"2021","journal-title":"AIDS research and therapy"},{"key":"pone.0281528.ref036","first-page":"939","article-title":"Social Networks and Barriers to ART Adherence Among Young Adults (18\u201324 years) Living with HIV at Selected Primary Health Facilities of South-Western Uganda: A Qualitative Study.","volume":"13","author":"N Ajuna","year":"2021","journal-title":"Hiv\/Aids"},{"issue":"9","key":"pone.0281528.ref037","doi-asserted-by":"crossref","first-page":"e620","DOI":"10.1016\/S2352-3018(20)30172-7","article-title":"Virological failure, HIV-1 drug resistance, and early mortality in adults admitted to hospital in Malawi: an observational cohort study","volume":"7","author":"A Gupta-Wright","year":"2020","journal-title":"The Lancet HIV"},{"issue":"1","key":"pone.0281528.ref038","doi-asserted-by":"crossref","first-page":"115","DOI":"10.3851\/IMP2437","article-title":"Rates of emergence of HIV drug resistance in resource-limited settings: a systematic review.","volume":"18","author":"KM Stadeli","year":"2013","journal-title":"Antiviral therapy.PubMed Central PMCID"},{"issue":"10","key":"pone.0281528.ref039","doi-asserted-by":"crossref","first-page":"2918","DOI":"10.1093\/jac\/dkw218","article-title":"Accumulation of HIV-1 drug resistance after continued virological failure on first-line ART in adults and children in sub-Saharan Africa","volume":"71","author":"TS Boender","year":"2016","journal-title":"Journal of Antimicrobial Chemotherapy"},{"key":"pone.0281528.ref040","article-title":"HIV Drug Resistance in Children and Adolescents: Always a Challenge?","author":"WLA Koay","year":"2021","journal-title":"Current Epidemiology Reports."},{"issue":"2","key":"pone.0281528.ref041","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1093\/jac\/dkab406","article-title":"Prevalence and patterns of HIV drug resistance in patients with suspected virological failure in North-Western Tanzania","volume":"77","author":"S Henerico","year":"2022","journal-title":"The Journal of antimicrobial chemotherapy"},{"issue":"2","key":"pone.0281528.ref042","doi-asserted-by":"crossref","first-page":"e0118145","DOI":"10.1371\/journal.pone.0118145","article-title":"High prevalence of the K65R mutation in HIV-1 subtype C infected patients failing tenofovir-based first-line regimens in South Africa.","volume":"10","author":"L Skhosana","year":"2015","journal-title":"PloS one"},{"issue":"2","key":"pone.0281528.ref043","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1089\/aid.2017.0198","article-title":"Distinct Pattern of Thymidine Analogue Mutations with K65R in Patients Failing Tenofovir-Based Antiretroviral Therapy","volume":"34","author":"B Chaplin","year":"2018","journal-title":"AIDS research and human retroviruses"},{"issue":"5","key":"pone.0281528.ref044","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1093\/jac\/dkw583","article-title":"Rapid accumulation of HIV-1 thymidine analogue mutations and phenotypic impact following prolonged viral failure on zidovudine-based first-line ART in sub-Saharan Africa","volume":"72","author":"RL Goodall","year":"2017","journal-title":"The Journal of antimicrobial chemotherapy"},{"issue":"4","key":"pone.0281528.ref045","doi-asserted-by":"crossref","first-page":"e02557","DOI":"10.1128\/AAC.02557-19","article-title":"Antiviral Activity of Tenofovir Alafenamide against HIV-1 with Thymidine Analog-Associated Mutations and M184V","volume":"64","author":"NR Margot","year":"2020","journal-title":"Antimicrobial agents and chemotherapy"},{"issue":"5","key":"pone.0281528.ref046","doi-asserted-by":"crossref","first-page":"2310","DOI":"10.1093\/nar\/gkw060","article-title":"Biochemical characterization of a multi-drug resistant HIV-1 subtype AG reverse transcriptase: antagonism of AZT discrimination and excision pathways and sensitivity to RNase H inhibitors","volume":"44","author":"A Schneider","year":"2016","journal-title":"Nucleic Acids Res"},{"issue":"3","key":"pone.0281528.ref047","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/S1473-3099(16)30469-8","article-title":"Occult HIV-1 drug resistance to thymidine analogues following failure of first-line tenofovir combined with a cytosine analogue and nevirapine or efavirenz in sub Saharan Africa: a retrospective multi-centre cohort study","volume":"17","author":"J Gregson","year":"2017","journal-title":"The Lancet Infectious Diseases"},{"issue":"5","key":"pone.0281528.ref048","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/S1473-3099(15)00536-8","article-title":"Global epidemiology of drug resistance after failure of WHO recommended first-line regimens for adult HIV-1 infection: a multicentre retrospective cohort study","volume":"16","author":"J Gregson","year":"2016","journal-title":"The Lancet Infectious Diseases"},{"issue":"6","key":"pone.0281528.ref049","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1089\/aid.2012.0218","article-title":"Short communication: high rates of thymidine analogue mutations and dual-class resistance among HIV-infected Ugandan children failing first-line antiretroviral therapy","volume":"29","author":"KC Sigaloff","year":"2013","journal-title":"AIDS research and human retroviruses"},{"issue":"7","key":"pone.0281528.ref050","doi-asserted-by":"crossref","first-page":"1948","DOI":"10.1093\/jac\/dkw071","article-title":"Development of a G118R mutation in HIV-1 integrase following a switch to dolutegravir monotherapy leading to cross-resistance to integrase inhibitors","volume":"71","author":"BG Brenner","year":"2016","journal-title":"The Journal of antimicrobial chemotherapy"},{"issue":"1","key":"pone.0281528.ref051","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1186\/s12879-021-06059-x","article-title":"Interaction analysis of statistically enriched mutations identified in Cameroon recombinant subtype CRF02_AG that can influence the development of Dolutegravir drug resistance mutations","volume":"21","author":"SG Mikasi","year":"2021","journal-title":"BMC infectious diseases"},{"issue":"6","key":"pone.0281528.ref052","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1093\/jac\/dkw039","article-title":"Prevalence and dynamics of the K65R drug resistance mutation in HIV-1-infected infants exposed to maternal therapy with lamivudine, zidovudine and either nevirapine or nelfinavir in breast milk","volume":"71","author":"SC Inzaule","year":"2016","journal-title":"The Journal of antimicrobial chemotherapy"},{"issue":"10","key":"pone.0281528.ref053","doi-asserted-by":"crossref","first-page":"1635","DOI":"10.1097\/QAD.0000000000002234","article-title":"Simplifying switch to second-line antiretroviral therapy in sub Saharan Africa: predicted effect of using a single viral load to define efavirenz-based first-line failure","volume":"33","author":"A Shroufi","year":"2019","journal-title":"Aids"},{"issue":"1","key":"pone.0281528.ref054","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1186\/s40249-017-0377-0","article-title":"Sensitive detection of HIV-1 resistance to Zidovudine and impact on treatment outcomes in low- to middle-income countries.","volume":"6","author":"RM Gibson","year":"2017","journal-title":"Infectious diseases of poverty."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0281528","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,23]],"date-time":"2023-02-23T13:32:42Z","timestamp":1677159162000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0281528"}},"subtitle":[],"editor":[{"given":"Jason T.","family":"Blackard","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,2,23]]},"references-count":54,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0281528","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,23]]}}}