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Objectives: This study aimed to assess the frequency of first-line antiretroviral therapy (ART) resistance among HIV patients and to identify the factors affecting the drug resistance. Methods: A cross-sectional study was conducted over a sample of 162 HIV-positive patients attending the Medicine Department of Lady Reading Hospital, Peshawar-Pakistan, from July 2020 to January 2021. Blood samples were collected for phylogenic profiles to determine first-line antiretroviral therapy resistance. Results: The frequency of ART resistance was detected in 64.8% of the enrolled HIV patients. Factors such as patient age, gender, comorbidities, and smoking status had no significant impact on drug resistance. While only body mass index (BMI) significantly affected ART resistance among HIV patients. The drug resistance mutations M184V and K103N were detected in the nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs), respectively, whereas the mutations G73SC and I47VA were detected in the protease inhibitors (PIs). Conclusion: There is a high frequency of resistance to first-line antiretroviral therapy among HIV patients presenting to the selected healthcare facility in Peshawar. Furthermore, we found no significant factors impacting ART resistance among HIV patients other than BMI. [ABSTRACT FROM AUTHOR]