Dolutegravir Resistance in African Programmatic Settings Among Patients With Failure of Dolutegravir-based ART

• DOI: 10.1093/ofid/ofae321
• Publication Date: 2024-06-05T16:21:36Z
• Authors: Richard A Murphy; Pradeep H Bedesi; Nirmala Perumal; Bernadett I Gosnell; Timothy J Hatlen; Jaysingh Brijkumar
• Keywords: Dolutegravir; Regimen; Darunavir; HIV drug resistance

Abstract Dolutegravir resistance is emerging in routine clinical contexts southern Africa, primarily patients with prior treatment experience failing dolutegravir-based antiretroviral therapy (ART). This potential issue was raised by The Nucleosides and Darunavir/Dolutegravir Africa trial that compared dolutegravir boosted protease inhibitor–based as second-line ART, which new observed at failure. However, recent data suggest also risk are who were transitioned to from non-nucleoside reverse transcriptase ART while viremic. Identifying experiencing failure of will be difficult given current gaps viral load monitoring limited capacity for genotypic testing. As a result, the short term, most affected go unrecognized, particularly important implications have advanced HIV or pregnant/breastfeeding. Prospective research needed understand scope problem, identify additional factors, determine best management. In inhibitor exposure, option timely switch regimen anchored inhibitor, high genetic barrier resistance.