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Background: Transmitted drug resistance (TDR) in antiretroviral (ART)-naïve patients remains a serious concern since it can reduce the efficacy of treatment and may affect clinical outcomes. The aim of this retrospective study is to describe circulating viral subtypes and evaluate the prevalence of TDR in drug naïve patients from Sapienza University Hospital. Materials/methods: Genotypic resistance tests (GRT) of 668 ART-naïve patients attending Sapienza University Hospital, Rome, between 2005 and 2017 were analyzed. GRT were conducted in integrase (n= 52), protease and reverse transcriptase (RT)(n= 668) sequences (Trugene® HIV-1 Genotyping Kit, Siemens; ViroSeq™ HIV-1 Genotyping System, Abbott). Results: Most of patients were male (76.1%), of Italian origin (70.9%), with a median age of 38 years (IQR 31-48 years); the median viral load was 4.7 log10 copies/mL (IQR 4.1-5.3) and the mean baseline CD4 cell count was 352 cells/mm3 (IQR 148-570). Phylogenetic analysis revealed the presence of 21 different subtypes and Circulating Recombinant Forms (CRFs). Subtype B was most common (67.1%), followed by CRF02_AG (8.4%), subtypes C and F (6%). A significantly increased overtime in the proportion of non-B strains (p< 0.001) and in the rates of nonItalians patients (p< 0.001) was found. Most individuals (92.7%) had no TDR mutations and were susceptible to all drugs. The overall prevalence of TDR was 9.4%[nucleoside reverse transcriptase inhibitors (NRTIs)= 4.2%, non-nucleoside reverse transcriptase inhibitors (NNRTIs)= 5.8%, protease inhibitors (PIs)= 1.0%] and was higher in subtype B strains. The most common …