**Retention in Care, Mortality, Loss-to-Follow-Up, and Viral Suppression among Antiretroviral Treatment-Naïve and Experienced Persons Participating in a Nationally Representative HIV Pre-Treatment Drug Resistance Survey in Mexico**

**Yanink Caro-Vega 1, Fernando Alarid-Escudero 2, Eva A. Enns 3, Sandra Sosa-Rubí 4, Carlos Chivardi 4, Alicia Piñeirúa-Menendez 5, Claudia García-Morales 6, Gustavo Reyes-Terán 6, Juan G. Sierra-Madero 1 and Santiago Ávila-Ríos 6,\***


6 Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, MexicoCity14080,Mexico;claudia.garcia@cieni.org.mx(C.G.-M.);gustavo.reyesteran@gmail.com(G.R.-T.)

 Correspondence:santiago.avila@cieni.org.mx;Tel.:+52-(55)-5666-7985(ext.133)

**Abstract:** We describe associations of pretreatment drug resistance (PDR) with clinical outcomes such as remaining in care, loss to follow-up (LTFU), viral suppression, and death in Mexico, in real-life clinical settings. We analyzed clinical outcomes after a two-year follow up period in participants of a large 2017–2018 nationally representative PDR survey cross-referenced with information of the national ministry of health HIV database. Participants were stratified according to prior ART exposure and presence of efavirenz/nevirapine PDR. Using a Fine-Gray model, we evaluated virological suppression among resistant patients, in a context of competing risk with lost to follow-up and death. A total of 1823 participants were followed-up by a median of 1.88 years (Interquartile Range (IQR): 1.59–2.02): 20 (1%) were classified as experienced + resistant; 165 (9%) naïve + resistant; 211 (11%) experienced + non-resistant; and 1427 (78%) as naïve + non-resistant. Being ART-experienced was associated with a lower probability of remaining in care (adjusted Hazard Ratio(aHR) = 0.68, 0.53–0.86, for the non-resistant group and aHR = 0.37, 0.17–0.84, for the resistant group, compared to the naïve + non-resistant group). Heterosexual cisgender women compared to men who have sex with men [MSM], had a lower viral suppression (aHR = 0.84, 0.70–1.01, *p* = 0.06) ART-experienced persons with NNRTI-PDR showed the worst clinical outcomes. This group was enriched with women and persons with lower education and unemployed, which suggests higher levels of social vulnerability.

**Keywords:** HIV; drug resistance; surveillance; public health; Mexico
