This study confirmed that mutation pathways for raltegravir resistance could be different between the two subtypes CRF02_AG and B with a preferential use of the 155 mutation in non-B subtypes. A new genetic pathway associated with raltegravir resistance, including the 118R mutation, has also been identified. This new genetic pathway, never described in subtype B, should be further evaluated for phenotypic susceptibility to dolutegravir and MK-2048.

During firefighting, thermoregulation is challenged due to a combination of harsh environmental conditions, high metabolic rates and personal protective clothing (PPC). Consequently, investigations of thermoregulation in firefighters should not only consider climate and exercise intensity, but technical properties of textiles too. Therefore, laboratory textile performance simulations may provide additional insights into textile-dependent thermoregulatory responses to exercise. In order to investigate the thermo-physiological relevance of textile properties and to test how different garments affect thermoregulation at different exercise intensities, we analyzed the results of a standard laboratory test and human subject trials by relating functional properties of textiles to thermo-physiological responses. Ten professional, healthy, male firefighters (age: 43 ± 6 y, weight: 84.3 ± 10.3kg, height: 1.79 ± 0.05m) performed low and moderate intensity exercise wearing garments previously evaluated with a sweating torso system to characterize thermal and evaporative properties. Functional properties of PPC and the control garment differed markedly. Consequently, skin temperature was higher using PPC at both exercise intensities (low: 36.27 ± 0.32 versus 36.75 ± 0.15℃, P < 0.05; moderate: 36.53 ± 0.34 versus 37.18 ± 0.23℃, P < 0.001), while core body temperature was only higher for PPC at moderate (37.54 ± 0.24 versus 37.83 ± 0.27℃, P < 0.05), but not low-intensity exercise (37.26 ± 0.21 versus 37.21 ± 0.19, P = 0.685). Differences in thermal and evaporative properties between textiles are reflected in thermo-physiological responses during human subject trials. However, an appropriate exercise intensity has to be chosen in order to challenge textile performance during exercise tests.

Fabric systems used in firefighters' thermal protective clothing should offer optimal thermal protective and thermo-physiological comfort performances. However, fabric systems that have very high thermal protective performance have very low thermo-physiological comfort performance. As these performances are inversely related, a categorization tool based on these two performances can help to find the best balance between them. Thus, this study is aimed at developing a tool for categorizing fabric systems used in protective clothing. For this, a set of commercially available fabric systems were evaluated and categorized. The thermal protective and thermo-physiological comfort performances were measured by standard tests and indexed into a normalized scale between 0 (low performance) and 1 (high performance). The indices dataset was first divided into three clusters by using the k-means algorithm. Here, each cluster had a centroid representing a typical Thermal Protective Performance Index (TPPI) value and a typical Thermo-physiological Comfort Performance Index (TCPI) value. By using the ISO 11612:2015 and EN 469:2014 guidelines related to the TPPI requirements, the clustered fabric systems were divided into two groups: Group 1 (high thermal protective performance-based fabric systems) and Group 2 (low thermal protective performance-based fabric systems). The fabric systems in each of these TPPI groups were further categorized based on the typical TCPI values obtained from the k-means clustering algorithm. In this study, these categorized fabric systems showed either high or low thermal protective performance with low, medium, or high thermo-physiological comfort performance. Finally, a tool for using these categorized fabric systems was prepared and presented graphically. The allocations of the fabric systems within the categorization tool have been verified based on their properties (e.g., thermal resistance, weight, evaporative resistance) and construction parameters (e.g., woven, nonwoven, layers), which significantly affect the performance. In this way, we identified key characteristics among the categorized fabric systems which can be used to upgrade or develop high-performance fabric systems. Overall, the categorization tool developed in this study could help clothing manufacturers or textile engineers select and/or develop appropriate fabric systems with maximum thermal protective performance and thermo-physiological comfort performance. Thermal protective clothing manufactured using this type of newly developed fabric system could provide better occupational health and safety for firefighters.

It is currently unclear how the assembly of different fabric layers of personal protective clothing (PPC) contributes to differences in thermal comfort among garments. Therefore, we used two different approaches to investigate the effect of PPC on body heat dissipation: a technical characterization of textiles (using sweating Torso methodology) and thermo-physiological wearing trials. We hypothesized that the technical characterization provides a similar outcome compared to the wearing trials and, thus, proves to have high thermo-physiological relevance. Thirteen different PPC were investigated using the sweating Torso methodology. Three out of these thirteen were then selected for inclusion in a series of human subject trials in a hot environment. Results from human trials and Torso testing were related to each other. The thermal and evaporative properties of the selected PPC typically differed and effects were observed for the thermo-physiological responses of human study participants. Differences in Torso surface temperature of up to 9℃ and moisture accumulation in the protective clothing systems of up to 184 g·m–2 were detected using the sweating Torso methodology. Moderate intensity exercise with the human study participants induced textile-dependent differences of up to 0.9 ± 0.2℃ (P < 0.001) and 1.2 ± 0.2℃ (P = 0.008) for excessive core body and excessive skin temperature, respectively. Using the sweating Torso methodology, physiologically relevant differences in textile performance could be detected among different PPC. Consequently, sweating Torso is a relevant tool to gain insight into human thermo-physiological responses to different PPC with similar end-use based on their dry and wet heat transfer characteristics.