**5. Conclusions**

The present study showed a continued increasing trend of NNRTI PDR in the context of Mexico City's HIV epidemic in 2017–2020, which was strongly associated with ongoing NNRTI DRM transmission, even with a much lower efavirenz use. It is reassuring that both PDR and ADR to dolutegravir and bictegravir have remained low locally after the widespread rollout of ART first-line regimens based on these drugs locally. Our study also identified demographic characteristics of groups with higher risk of PDR and higher probability of becoming lost to follow-up, in particular, ART restarters. The observations of the present study may be useful to guide clinical care algorithm design within the Condesa clinics in order to identify persons with these profiles who may need specific interventions differentiated from the rest of the population. In the same sense, our observations warrant further in-depth studies in the population of cisgender women, young MSM, and adolescents in order to design better strategies for retention in care and viral suppression.

**Supplementary Materials:** The following are available online at https://www.mdpi.com/article/ 10.3390/pathogens10121587/s1, Figure S1. Pretreatment drug resistance trends in Mexico City by antiretroviral drug, 2017–2020; Figure S2. Pretreatment antiretroviral drug resistance mutation frequency trends in Mexico City, 2017–2020; Table S1. Demographic, clinical, and behavioral characteristics of antiretroviral treatment restarters.

**Author Contributions:** Conceptualization, S. Á.-R. and C.G.-M.; methodology, D.T.-T., M.M.-F., V.S.Q.-M.; software, E.Z.-S.; formal analysis, C.G.-M. and V.D.-C.; investigation, S. Á.-R. and C.G.-M.; resources, S. Á.-R., G.R.-T. and A.G.-R.; local sampling, P.I.-H., R.G.-M., R.A.C. and A.G.-C.; data collection, Á.B.-B., M.C.-S. and M.B.-R.; participant recruitment, I.M.-G., Á.B.-B., M.C.-S. and M.B.-R.; data curation, C.G.-M. and D.T.-T.; writing—original draft preparation, S. Á.-R. and C.G.-M.; writing— review and editing, all authors; funding acquisition, G.R.-T., A.G.-R. and S. Á.-R. All authors have read and agreed to the published version of the manuscript.

**Funding:** This work was supported by Consejo Nacional de Ciencia y Tecnología (PRONAII Virología 303079 and CONACyT SALUD-2017-01-289725), the Mexican Government (Programa Presupuestal P016; Anexo 13 del Decreto del Presupuesto de Egresos de la Federación), the Canadian Institutes of Health Research (PJT-148621 and PJT-159625), the San Diego Center for AIDS Research International Pilot Grant (P30 AI036214, subaward no. 112605914). Á.B.-B. was supported by a scholarship from the AIDS Healthcare Foundation (AHF) Mexico.

**Institutional Review Board Statement:** The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of the National Institute of Respiratory Diseases (protocol code E02-17 approved on 1 October 2016 and E20-20 approved on 23 January 2020).

**Informed Consent Statement:** Written informed consent was obtained from all subjects involved in the study, except for individuals included in the acquired drug resistance analysis, for which national surveillance data were used, without the interaction of researchers and study participants.

**Data Availability Statement:** Data sets supporting the observations of the present study are available upon request from the corresponding author.

**Acknowledgments:** The authors would like to thank Edna Rodríguez-Aguirre for performing CD4+ T cell counts; Ramón Hernández-Juan for performing viral loads, Eduardo <sup>L</sup>ópez-Ortiz for assistance in figure preparation, the laboratory staff at Condesa Specialised Clinic: Karina Nava-Memije, Maritza M. García-Lucas, Alieth A. Piña-Cruz, and the administrative staff at CIENI/INER: Guadalupe

Hernández-Reyes, Marisol Cruz, María de Jesús Espinosa, Omar Quevedo, Ofelia Gómez-Guerrero, Dania Pulido-Ravelo, Diana Ek-Reyes.

**Conflicts of Interest:** The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.
