PDR was estimated using the HIVdb tool from Sanger sequences. Individuals with drug resistance were defined as those with at least low-level resistance (Stanford penalty score ≥15) to any drug of the corresponding class. A. PDR levels by antiretroviral drug class. B. PDR levels by drug resistance mutation; relevant mutations for PDR to the most widely used ART regimens in Nicaragua are shown. C. PDR trends by year of enrolment in recently infected individuals only. D-E PDR levels by antiretroviral drug in individuals with recent and long-standing infection; drug resistance levels were classified according to the Stanford Score, as explained for Fig 3. The number of patients enrolled by year was 17, 88, 69, 61, and 48 for 2011, 2012, 2013, 2014, and 2015 respectively.