{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T16:15:04Z","timestamp":1765728904024,"version":"build-2065373602"},"reference-count":29,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,4,17]],"date-time":"2024-04-17T00:00:00Z","timestamp":1713312000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"FCT in the Scopus of INTEGRIV project","award":["PTDC\/SAU-INF\/31990\/2017","PTDC\/SAU-PUB\/4018\/2021","250466","AREF-312-CRUZ-F-C0931","36 MESCTI\/PDCT\/2022","GHTM-UID\/04413\/2020","LA-REAL-LA\/P\/0117\/2020","CEECINST\/00102\/2018\/CP1567\/CT0040","10.54499\/UIDB\/04585\/2020"],"award-info":[{"award-number":["PTDC\/SAU-INF\/31990\/2017","PTDC\/SAU-PUB\/4018\/2021","250466","AREF-312-CRUZ-F-C0931","36 MESCTI\/PDCT\/2022","GHTM-UID\/04413\/2020","LA-REAL-LA\/P\/0117\/2020","CEECINST\/00102\/2018\/CP1567\/CT0040","10.54499\/UIDB\/04585\/2020"]}]},{"name":"FCT MARVEL","award":["PTDC\/SAU-INF\/31990\/2017","PTDC\/SAU-PUB\/4018\/2021","250466","AREF-312-CRUZ-F-C0931","36 MESCTI\/PDCT\/2022","GHTM-UID\/04413\/2020","LA-REAL-LA\/P\/0117\/2020","CEECINST\/00102\/2018\/CP1567\/CT0040","10.54499\/UIDB\/04585\/2020"],"award-info":[{"award-number":["PTDC\/SAU-INF\/31990\/2017","PTDC\/SAU-PUB\/4018\/2021","250466","AREF-312-CRUZ-F-C0931","36 MESCTI\/PDCT\/2022","GHTM-UID\/04413\/2020","LA-REAL-LA\/P\/0117\/2020","CEECINST\/00102\/2018\/CP1567\/CT0040","10.54499\/UIDB\/04585\/2020"]}]},{"name":"Calouste Gulbenkian Foundation (FCG)","award":["PTDC\/SAU-INF\/31990\/2017","PTDC\/SAU-PUB\/4018\/2021","250466","AREF-312-CRUZ-F-C0931","36 MESCTI\/PDCT\/2022","GHTM-UID\/04413\/2020","LA-REAL-LA\/P\/0117\/2020","CEECINST\/00102\/2018\/CP1567\/CT0040","10.54499\/UIDB\/04585\/2020"],"award-info":[{"award-number":["PTDC\/SAU-INF\/31990\/2017","PTDC\/SAU-PUB\/4018\/2021","250466","AREF-312-CRUZ-F-C0931","36 MESCTI\/PDCT\/2022","GHTM-UID\/04413\/2020","LA-REAL-LA\/P\/0117\/2020","CEECINST\/00102\/2018\/CP1567\/CT0040","10.54499\/UIDB\/04585\/2020"]}]},{"name":"Africa Research Excellence Fund (AREF)","award":["PTDC\/SAU-INF\/31990\/2017","PTDC\/SAU-PUB\/4018\/2021","250466","AREF-312-CRUZ-F-C0931","36 MESCTI\/PDCT\/2022","GHTM-UID\/04413\/2020","LA-REAL-LA\/P\/0117\/2020","CEECINST\/00102\/2018\/CP1567\/CT0040","10.54499\/UIDB\/04585\/2020"],"award-info":[{"award-number":["PTDC\/SAU-INF\/31990\/2017","PTDC\/SAU-PUB\/4018\/2021","250466","AREF-312-CRUZ-F-C0931","36 MESCTI\/PDCT\/2022","GHTM-UID\/04413\/2020","LA-REAL-LA\/P\/0117\/2020","CEECINST\/00102\/2018\/CP1567\/CT0040","10.54499\/UIDB\/04585\/2020"]}]},{"name":"Science and Technology Development Project (PDCT)","award":["PTDC\/SAU-INF\/31990\/2017","PTDC\/SAU-PUB\/4018\/2021","250466","AREF-312-CRUZ-F-C0931","36 MESCTI\/PDCT\/2022","GHTM-UID\/04413\/2020","LA-REAL-LA\/P\/0117\/2020","CEECINST\/00102\/2018\/CP1567\/CT0040","10.54499\/UIDB\/04585\/2020"],"award-info":[{"award-number":["PTDC\/SAU-INF\/31990\/2017","PTDC\/SAU-PUB\/4018\/2021","250466","AREF-312-CRUZ-F-C0931","36 MESCTI\/PDCT\/2022","GHTM-UID\/04413\/2020","LA-REAL-LA\/P\/0117\/2020","CEECINST\/00102\/2018\/CP1567\/CT0040","10.54499\/UIDB\/04585\/2020"]}]},{"name":"FCT","award":["PTDC\/SAU-INF\/31990\/2017","PTDC\/SAU-PUB\/4018\/2021","250466","AREF-312-CRUZ-F-C0931","36 MESCTI\/PDCT\/2022","GHTM-UID\/04413\/2020","LA-REAL-LA\/P\/0117\/2020","CEECINST\/00102\/2018\/CP1567\/CT0040","10.54499\/UIDB\/04585\/2020"],"award-info":[{"award-number":["PTDC\/SAU-INF\/31990\/2017","PTDC\/SAU-PUB\/4018\/2021","250466","AREF-312-CRUZ-F-C0931","36 MESCTI\/PDCT\/2022","GHTM-UID\/04413\/2020","LA-REAL-LA\/P\/0117\/2020","CEECINST\/00102\/2018\/CP1567\/CT0040","10.54499\/UIDB\/04585\/2020"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Background: The global scale-up of antiretroviral treatment (ART) offers significant health benefits by suppressing HIV-1 replication and increasing CD4 cell counts. However, incomplete viral suppression poses a potential threat for the emergence of drug resistance mutations (DRMs), limiting ART options, and increasing HIV transmission. Objective: We investigated the patterns of transmitted drug resistance (TDR) and acquired drug resistance (ADR) among HIV-1 patients in Portugal. Methods: Data were obtained from 1050 HIV-1 patient samples submitted for HIV drug resistance (HIVDR) testing from January 2022 to June 2023. Evaluation of DRM affecting viral susceptibility to nucleoside\/tide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and integrase strand transfer inhibitors (INSTIs) was performed using an NGS technology, the Vela Diagnostics Sentosa SQ HIV-1 Genotyping Assay. Results: About 71% of patients were ART na\u00efve and 29% were experienced. Overall, 20% presented with any DRM. The prevalence of TDR and ADR was 12.6% and 41.1%, respectively. M184V, T215S, and M41L mutations for NRTI, K103N for NNRTI, and M46I\/L for PIs were frequent in na\u00efve and treated patients. E138K and R263K mutations against INSTIs were more frequent in na\u00efve than treated patients. TDR and ADR to INSTIs were 0.3% and 7%, respectively. Patients aged 50 or over (OR: 1.81, p = 0.015), originating from Portuguese-speaking African countries (PALOPs) (OR: 1.55, p = 0.050), HIV-1 subtype G (OR: 1.78, p = 0.010), and with CD4 &lt; 200 cells\/mm3 (OR: 1.70, p = 0.043) were more likely to present with DRMs, while the males (OR: 0.63, p = 0.003) with a viral load between 4.1 to 5.0 Log10 (OR: 0.55, p = 0.003) or greater than 5.0 Log10 (OR: 0.52, p &lt; 0.001), had lower chances of presenting with DRMs. Conclusions: We present the first evidence on TDR and ADR to INSTI regimens in followed up patients presenting for healthcare in Portugal. We observed low levels of TDR to INSTIs among ART-na\u00efve and moderate levels in ART-exposed patients. Regimens containing PIs could be an alternative second line in patients with intermediate or high-level drug resistance, especially against second-generation INSTIs (dolutegravir, bictegravir, and cabotegravir).<\/jats:p>","DOI":"10.3390\/v16040622","type":"journal-article","created":{"date-parts":[[2024,4,17]],"date-time":"2024-04-17T08:22:44Z","timestamp":1713342164000},"page":"622","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Applying Next-Generation Sequencing to Track HIV-1 Drug Resistance Mutations Circulating in Portugal"],"prefix":"10.3390","volume":"16","author":[{"given":"Victor","family":"Pimentel","sequence":"first","affiliation":[{"name":"Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Rua da Junqueira 100, 1349-008 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7928-3087","authenticated-orcid":false,"given":"Marta","family":"Pingarilho","sequence":"additional","affiliation":[{"name":"Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Rua da Junqueira 100, 1349-008 Lisbon, Portugal"}]},{"given":"Cruz S.","family":"Sebasti\u00e3o","sequence":"additional","affiliation":[{"name":"Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Rua da Junqueira 100, 1349-008 Lisbon, Portugal"},{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade de Angola (CISA), Caxito, Angola"},{"name":"Instituto Nacional de Investiga\u00e7\u00e3o em Sa\u00fade (INIS), Luanda, Angola"}]},{"given":"Mafalda","family":"Miranda","sequence":"additional","affiliation":[{"name":"Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Rua da Junqueira 100, 1349-008 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2124-5811","authenticated-orcid":false,"given":"F\u00e1tima","family":"Gon\u00e7alves","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Biologia Molecular, Servi\u00e7o de Patologia Cl\u00ednica, Unidade Local de Sa\u00fade Lisboa Ocidental, Hospital Egas Moniz, 1349-019 Lisbon, Portugal"}]},{"given":"Joaquim","family":"Cabanas","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Biologia Molecular, Servi\u00e7o de Patologia Cl\u00ednica, Unidade Local de Sa\u00fade Lisboa Ocidental, Hospital Egas Moniz, 1349-019 Lisbon, Portugal"}]},{"given":"In\u00eas","family":"Costa","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Biologia Molecular, Servi\u00e7o de Patologia Cl\u00ednica, Unidade Local de Sa\u00fade Lisboa Ocidental, Hospital Egas Moniz, 1349-019 Lisbon, Portugal"}]},{"given":"Isabel","family":"Diogo","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Biologia Molecular, Servi\u00e7o de Patologia Cl\u00ednica, Unidade Local de Sa\u00fade Lisboa Ocidental, Hospital Egas Moniz, 1349-019 Lisbon, Portugal"}]},{"given":"Sandra","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Biologia Molecular, Servi\u00e7o de Patologia Cl\u00ednica, Unidade Local de Sa\u00fade Lisboa Ocidental, Hospital Egas Moniz, 1349-019 Lisbon, Portugal"}]},{"given":"Olga","family":"Costa","sequence":"additional","affiliation":[{"name":"Biologia Molecular, Servi\u00e7o de Patologia Cl\u00ednica, Centro Hospitalar de Lisboa Central, 1150-199 Lisbon, Portugal"}]},{"given":"Rita","family":"Corte-Real","sequence":"additional","affiliation":[{"name":"Biologia Molecular, Servi\u00e7o de Patologia Cl\u00ednica, Centro Hospitalar de Lisboa Central, 1150-199 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7941-0285","authenticated-orcid":false,"given":"M. Ros\u00e1rio O.","family":"Martins","sequence":"additional","affiliation":[{"name":"Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Rua da Junqueira 100, 1349-008 Lisbon, Portugal"}]},{"given":"Sofia G.","family":"Seabra","sequence":"additional","affiliation":[{"name":"Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Rua da Junqueira 100, 1349-008 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3903-5265","authenticated-orcid":false,"given":"Ana B.","family":"Abecasis","sequence":"additional","affiliation":[{"name":"Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Rua da Junqueira 100, 1349-008 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3271-8255","authenticated-orcid":false,"given":"Perp\u00e9tua","family":"Gomes","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Biologia Molecular, Servi\u00e7o de Patologia Cl\u00ednica, Unidade Local de Sa\u00fade Lisboa Ocidental, Hospital Egas Moniz, 1349-019 Lisbon, Portugal"},{"name":"Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, 2829-511 Almada, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,17]]},"reference":[{"unstructured":"WHO (2016). Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach, WHO.","key":"ref_1"},{"key":"ref_2","first-page":"156","article-title":"2011 Update of the Drug Resistance Mutations in HIV-1","volume":"19","author":"Johnson","year":"2011","journal-title":"Top. Antivir. Med."},{"doi-asserted-by":"crossref","unstructured":"Bennett, D.E., Camacho, R.J., Otelea, D., Kuritzkes, D.R., Fleury, H., Kiuchi, M., Heneine, W., Kantor, R., Jordan, M.R., and Schapiro, J.M. (2009). Drug Resistance Mutations for Surveillance of Transmitted HIV-1 Drug-Resistance: 2009 Update. PLoS ONE, 4.","key":"ref_3","DOI":"10.1371\/journal.pone.0004724"},{"unstructured":"WHO (2021). HIV Drug Resistance Report 2021, WHO.","key":"ref_4"},{"key":"ref_5","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":"Clutter","year":"2016","journal-title":"Infect. Genet. Evol."},{"doi-asserted-by":"crossref","unstructured":"Rossetti, B., Incardona, F., Di Teodoro, G., Mommo, C., Saladini, F., Kaiser, R., S\u00f6nnerborg, A., Lengauer, T., and Zazzi, M. (2023). Cohort Profile: A European Multidisciplinary Network for the Fight against HIV Drug Resistance (EuResist Network). Trop. Med. Infect. Dis., 8.","key":"ref_6","DOI":"10.3390\/tropicalmed8050243"},{"doi-asserted-by":"crossref","unstructured":"Pingarilho, M., Pimentel, V., Miranda, M.N.S., Silva, A.R., Diniz, A., Ascen\u00e7\u00e3o, B.B., Pi\u00f1eiro, C., Koch, C., Rodrigues, C., and Caldas, C. (2022). HIV-1-Transmitted Drug Resistance and Transmission Clusters in Newly Diagnosed Patients in Portugal between 2014 and 2019. Front. Microbiol., 13.","key":"ref_7","DOI":"10.3389\/fmicb.2022.823208"},{"doi-asserted-by":"crossref","unstructured":"Miranda, M.N.S., Pingarilho, M., Pimentel, V., Martins, M.d.R.O., Kaiser, R., Seguin-Devaux, C., Paredes, R., Zazzi, M., Incardona, F., and Abecasis, A.B. (2022). Trends of Transmitted and Acquired Drug Resistance in Europe from 1981 to 2019: A Comparison Between the Populations of Late Presenters and Non-Late Presenters. Front. Microbiol., 13.","key":"ref_8","DOI":"10.3389\/fmicb.2022.846943"},{"doi-asserted-by":"crossref","unstructured":"Frescura, L., Godfrey-Faussett, P., Feizzadeh, A.A., El-Sadr, W., Syarif, O., and Ghys, P.D. (2022). Achieving the 95 95 95 Targets for All: A Pathway to Ending AIDS. PLoS ONE, 17.","key":"ref_9","DOI":"10.1371\/journal.pone.0272405"},{"doi-asserted-by":"crossref","unstructured":"Parkin, N.T., Avila-Rios, S., Bibby, D.F., Brumme, C.J., Eshleman, S.H., Harrigan, P.R., Howison, M., Hunt, G., Ji, H., and Kantor, R. (2020). Multi-Laboratory Comparison of next-Generation to Sanger-Based Sequencing for HIV-1 Drug Resistance Genotyping. Viruses, 12.","key":"ref_10","DOI":"10.3390\/v12070694"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1097\/COH.0000000000000737","article-title":"Technologies for HIV-1 Drug Resistance Testing: Inventory and Needs","volume":"17","author":"Metzner","year":"2022","journal-title":"Curr. Opin. HIV AIDS"},{"unstructured":"Minist\u00e9rio da Sa\u00fade (2023). Infe\u00e7\u00e3o por VIH em Portugal\u20132023, Dire\u00e7\u00e3o-Geral da Sa\u00fade\/Instituto Nacional de Sa\u00fade Doutor Ricardo Jorge.","key":"ref_12"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1763","DOI":"10.1093\/bioinformatics\/bty851","article-title":"VIRULIGN: Fast Codon-Correct Alignment and Annotation of Viral Genomes","volume":"35","author":"Libin","year":"2019","journal-title":"Bioinformatics"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3276","DOI":"10.1093\/bioinformatics\/btu531","article-title":"AliView: A Fast and Lightweight Alignment Viewer and Editor for Large Datasets","volume":"30","author":"Larsson","year":"2014","journal-title":"Bioinformatics"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/j.meegid.2013.04.032","article-title":"Automated Subtyping of HIV-1 Genetic Sequences for Clinical and Surveillance Purposes: Performance Evaluation of the New REGA Version 3 and Seven Other Tools","volume":"19","author":"Faria","year":"2013","journal-title":"Infect. Genet. Evol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e144","DOI":"10.1093\/nar\/gku739","article-title":"COMET: Adaptive Context-Based Modeling for Ultrafast HIV-1 Subtype Identification","volume":"42","author":"Struck","year":"2014","journal-title":"Nucleic Acids Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1641","DOI":"10.1093\/molbev\/msp077","article-title":"FastTree: Computing Large Minimum Evolution Trees with Profiles Instead of a Distance Matrix","volume":"26","author":"Price","year":"2009","journal-title":"Mol. Biol. Evol."},{"key":"ref_18","first-page":"e000093","article-title":"Microreact: Visualizing and Sharing Data for Genomic Epidemiology and Phylogeography","volume":"2","author":"Abudahab","year":"2016","journal-title":"Microb. Genom."},{"unstructured":"World Health Organisation (WHO) (2019). HIV Drug Resistance Report 2019, WHO.","key":"ref_19"},{"doi-asserted-by":"crossref","unstructured":"Pingarilho, M., Pimentel, V., Diogo, I., Fernandes, S., Miranda, M., Pineda-Pena, A., Libin, P., Theys, K., Martins, M., and Vandamme, A.-M. (2020). Increasing Prevalence of HIV-1 Transmitted Drug Resistance in Portugal: Implications for First Line Treatment Recommendations. Viruses, 12.","key":"ref_20","DOI":"10.1101\/2020.03.17.20033092"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1570","DOI":"10.1097\/00126334-200412150-00006","article-title":"Long-Term Persistence of Primary Genotypic Resistance after HIV-1 Seroconversion","volume":"37","author":"Pao","year":"2004","journal-title":"JAIDS J. Acquir. Immune Defic. Syndr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e29287","DOI":"10.1002\/jmv.29287","article-title":"Transmitted Drug Resistance to Antiretroviral Drugs in Spain during the Period 2019\u20132021","volume":"95","author":"Fuentes","year":"2023","journal-title":"J. Med. Virol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1628","DOI":"10.1093\/cid\/ciac972","article-title":"Transmitted Drug Resistance to Integrase-Based First-Line Human Immunodeficiency Virus Antiretroviral Regimens in Mediterranean Europe","volume":"76","author":"Fuentes","year":"2023","journal-title":"Clin. Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1111\/hiv.13262","article-title":"Effectiveness of Integrase Strand Transfer Inhibitors in HIV-infected Treatment-experienced Individuals across Europe","volume":"23","author":"Rossetti","year":"2022","journal-title":"HIV Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3517","DOI":"10.1093\/jac\/dkaa349","article-title":"Primary Resistance to Integrase Strand Transfer Inhibitors in Spain Using Ultrasensitive HIV-1 Genotyping","volume":"75","author":"Santos","year":"2020","journal-title":"J. Antimicrob. Chemother."},{"doi-asserted-by":"crossref","unstructured":"Pimentel, V., Pingarilho, M., Alves, D., Diogo, I., Fernandes, S., Miranda, M., Pineda-Pe\u00f1a, A.-C., Libin, P., Martins, M.R.O., and Vandamme, A.-M. (2020). Molecular Epidemiology of HIV-1 Infected Migrants Followed Up in Portugal: Trends between 2001\u20132017. Viruses, 12.","key":"ref_26","DOI":"10.3390\/v12030268"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"19683","DOI":"10.7448\/IAS.17.4.19683","article-title":"Characterization of HIV-1 Subtypes in a Portuguese Cohort","volume":"17","author":"Duro","year":"2014","journal-title":"J. Int. AIDS Soc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.1128\/JCM.03611-14","article-title":"Analysis of a Local HIV-1 Epidemic in Portugal Highlights Established Transmission of Non-B and Non-G Subtypes","volume":"53","author":"Carvalho","year":"2015","journal-title":"J. Clin. Microbiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1097\/QAD.0000000000003203","article-title":"Differential Patterns of Postmigration HIV-1 Infection Acquisition among Portuguese Immigrants of Different Geographical Origins","volume":"36","author":"Pimentel","year":"2022","journal-title":"AIDS"}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/16\/4\/622\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:29:09Z","timestamp":1760106549000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/16\/4\/622"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,17]]},"references-count":29,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,4]]}},"alternative-id":["v16040622"],"URL":"https:\/\/doi.org\/10.3390\/v16040622","relation":{},"ISSN":["1999-4915"],"issn-type":[{"type":"electronic","value":"1999-4915"}],"subject":[],"published":{"date-parts":[[2024,4,17]]}}}