36; 95% confidence interval (CI) 2.08, 5.42]. Greater than 95% adherence to ART (AOR 1.80; 95% CI 1.14–2.84) and having a baseline CD4 count >200 cells/μL (AOR 2.18; 95% CI 1.29–3.68) were also associated Lenvatinib supplier with having the maximum number of possible combinations. This study found that a high proportion of resistance mutations among individuals who initiated ART with NNRTI-based regimens had the potential to markedly reduce the number of future options for second-line drug regimens. This was demonstrated by the median GSS after use of NNRTI-based first-line regimens,

which was 9.8 as compared with 11.0 after boosted PI-based first-line regimens. The odds of having all available active combinations was more than three times higher in

participants who initiated treatment on boosted PIs. The study also showed that the proportion of individuals with more ART combinations for those who initiated boosted PI-based ART was almost twice that for those who initiated ART with NNRTIs. As HIV-positive individuals are now living longer, the availability of alternative drug options in the face of drug resistance becomes an important issue to consider. The clinical significance of this reduced GSS among ART-naïve patients starting with NNRTI-based regimens is that these patients may run out of drug DAPT price options among the readily available drugs in RLSs more rapidly. This problem is made worse by the higher cost of newer antiretroviral drugs. This also may contribute to the many factors leading to unbalanced benefits from ART between developed and the resource-limited settings. Although the absolute difference in GSS was small in terms of the median number of active drugs available in each group (9.8 vs. 11), the distribution

find more of these limitations for the NNRTI group was significant, such that over 40% of these patients had fewer than five drug combinations available to them after only 3 years of treatment. A recent cost-effectiveness analysis found that the use of boosted PI (lopinavir/ritonavir) as first-line therapy was very cost effective, especially in individuals with prior exposure to NNRTIs and those with unknown drug resistance profiles (cost-effectiveness ratio $1520/year of life saved versus first-line nevirapine) [23]. Given that in 2008 45% of HIV-infected women in RLSs had received some form of antiretroviral drugs (mainly nevirapine and/or zidovudine) for the prevention of mother-to-child transmission of HIV [24], and widespread resistance testing is not available in the region, consideration should be given to recommending boosted PIs as first-line therapy. This study confirmed that participants on NNRTI-based first-line regimens are more prone to develop antiretroviral drug resistance mutations as compared with those on boosted PI first-line regimens.