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The title, abstract and full text of eligible publications were scrutinized independently by two authors. Differences were resolved in consultation with the rest of the authors. Composite analysis and temporal trend of resistance mutations from to Studies with identifiable RT or PR sequences as per GenBank accession numbers were considered for cumulative analysis. Individual study specific sequences from India were retrieved from Los Alamos sequence database website http: To perform robust analysis, sequences were retrieved irrespective of sample size of the parent study.

Inclusion criteria for sequences were minimum amino acid coverage of 40 to for RT and 10 to 80 for PR region. Mutation analysis of year wise and pooled sequences were performed Free sex dating in chartley ma 2712 Stanford University HIV Drug Resistance program available at http: Time trend analysis was done using R software to look for any significant change in proportion of sequences showing NRTI resistance mutations among first line failure individuals over time R Development Core Team, All studies were conducted in urban settings with plasma as preferred sample. The successfully sequenced samples varied from 16 to per study.

The subjects in these cross-sectional studies were male dominated with heterosexual mode of transmission being commonest. The duration of infection prior to genotyping was variable, although a minimum exposure of ARV for 6 months was considered. Two studies carried out genotyping of all subjects with virological failure at 12 months of ART exposure Karade et al. Overall prevalence of any DRM varied from This variation could be due to different criteria of enrolment and starting sample. The rising trend in the yearly prevalence of NNRTI resistance mutation year onwards was also reported previously Neogi et al.

Multi-drug resistance mutations conferring resistance to most NRTI analogues such at 69 insertion complex and complex were reported infrequently Saravanan et al. With rapid scale up, emergence and spread of drug resistance is a major threat to the ultimate goal of National AIDS control programme to halt and reverse the epidemic. The development of resistance among ARV exposed group is inevitable, though it can be delayed by optimal adherence and monitoring.

The overall burden of resistance against agents of first-line regimen sexx remained steady over past decade. A dip in resistance observed in Fig 3a may be due to lesser number Free sex dating in chartley ma 2712 RT sequences 46 only available for analysis in that year. In India stavudine 27112 phased out from the National program in and TDF based fixed dose combination as preferred regimen was introduced inbased on WHO recommendations World Health Organization, Discrepant results have been reported in literature depending on technique used for genotyping. Although single dose NVP at the time of delivery was an important step towards prevention of parent to child transmission programme, widespread NVP exposure could be important factor for increasing trend of KN Kurle et al.

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