added to the virological resistance studies and manuscript revision. etravirine (78%) and darunavir/ritonavir (97%). Susceptibility to a second-line routine was significantly higher among ladies, younger individuals, those with higher nadir CD4+ T-cell counts, and those who experienced received lopinavir/ritonavir, but was lower among prior nevirapine recipients. Conclusions Highly divergent HIV drug resistance profiles were observed among candidates screened for third-line ART in LMIC, ranging from no resistance to resistance to 3 drug classes. These findings underscore the need for access to resistance screening and newer antiretrovirals for the optimal management of third-line ART in LMIC. Value= .44). Prior and ongoing ARV utilization by sex was related for the NRTI and integrase inhibitor classes and different for the NNRTI and PI classes. Specifically, males were more likely to have been exposed to EFV (64% for males vs 48% for females; .001) and ATV/r (57% for males vs 40% for females; .001), while females had more exposure to NVP (61% for CPA inhibitor males vs 70% for females; = .01) and LPV/r (65% for males vs 81% for females; .001). Human being Immunodeficiency VirusC1 Drug Resistance Profiles Of the 653 genotype results analyzed, 78% experienced resistance to at least 1 drug, but the remaining 22% experienced no drug resistance (ie, no intermediate or higher resistance to any drug) despite having a history of faltering first-line ART and being on a failing second-line routine (Table 2). The analysis showed that 62% experienced resistance (intermediate or higher) to 1 1 or more NRTI, 64% to 1 1 or more NNRTI, and CPA inhibitor 35% to 1 1 or more PI. Also, 24% experienced resistance to at least 1 drug in the NRTI class and at least 1 drug in the NNRTI class, and 26% experienced Mouse monoclonal to CD16.COC16 reacts with human CD16, a 50-65 kDa Fcg receptor IIIa (FcgRIII), expressed on NK cells, monocytes/macrophages and granulocytes. It is a human NK cell associated antigen. CD16 is a low affinity receptor for IgG which functions in phagocytosis and ADCC, as well as in signal transduction and NK cell activation. The CD16 blocks the binding of soluble immune complexes to granulocytes resistance to at least 1 drug in each of the 3 drug classes (NRTI, NNRTI, and PI; Number 2). Importantly, a slight majority (59%) showed susceptibility to a least 1 PI-containing second-line routine (defined as 2 NRTIs and either LPV/r or ATV/r; Table 2) and a large majority were vulnerable or experienced only low-level resistance to DRV/r (97%) and ETR (78%; Number 3). Table 2. Human being Immunodeficiency VirusC1 Drug Resistance by Country and Antiretroviral Class Valuebvalues .005. Abbreviations: 3TC, lamivudine; ABC, abacavir; ATV, atazanavir; D4T, stavudine; DDI, didanosine; DRV, darunavir; EFV, efavirenz; ETR, etravirine; FTC, emtricitabine; LPV, lopinavir; NNRTI, nonnucleoside reverse transcriptase inhibitor; NRTI, nucleoside reverse transcriptase inhibitor; NVP, nevirapine; PI = protease inhibitor; RPV, rilpivirine; TDF, tenofovir; ZDV, zidovudine. The most common NRTI mutation was M184V/I (57% of candidates), followed by thymidine analogue mutations at codons 215 (26%), 67 (22%), 41 (20%), 70 (18%), and 219 (18%). Mutations at codon K65R occurred at a very low rate of recurrence (3%). The most frequent NNRTI mutations were at codons K103 (34%), G190 (19%), and Y181 (15%), and the most frequent major PI mutations were at codons M46 (21%), A71 (21%), V82 (21%), and I54 (20%). PI-associated resistance was most common in the participants exposed only to ATV/r (46%), compared those exposed to LPV/r only (30%) or to both LPV/r and ATV/r (34%; = .002). Factors Associated with the Extent of Human being Immunodeficiency VirusC1 Drug Resistance Given the highly varied resistance profiles, we wanted to evaluate associations in both univariate and multivariate models between variables at screening (HIV RNA; nadir CD4+ T-cell count; sex; age; quantity or type of previous/ongoing NRTI, NNRTI, or PI exposure; ART duration variables; and country/subtype) and resistance by drug class. We also analyzed associations with susceptibility to a second-line ART routine. Detailed results of these analyses are demonstrated in Supplementary Furniture S1C4, and the most important findings are summarized below. Sex Sex was found to be associated with variations in resistance profiles in both univariable and multivariable analyses (Supplementary Furniture S1C4). The median duration of time on ART was related by sex; however, more males experienced resistance to at least 1 drug in the NRTI and PI classes, but not CPA inhibitor the NNRTI class, compared to ladies (NRTI, 69% vs 55%, respectively [ .001]; PI, 45% CPA inhibitor vs 24%, respectively [ .001]; NNRTI, 64% vs 64%, respectively [= .94]). More males (34%) than ladies (17%) experienced resistance to at least 1 drug in each of the 3 drug classes ( .001). Susceptibility to a Second-line Antiretroviral Therapy Routine.