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An Affordable HIV-1 Drug Resistance Monitoring Method for Resource Limited Settings
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How frequent is dolutegravir resistance?

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Dolutegravir resistance in low-income countries is rare, emerging mainly in individuals with adherence issues. Minor program adjustments can improve outcomes, highlighting the need for adherence support and stable drug supply chains for HIV treatment success.

Keywords:
DolutegravirG118RHIVR263Kdrug resistancelow- and middle-income countries

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Area of Science:

  • Virology
  • Infectious Diseases
  • Public Health

Background:

  • HIV remains a significant global health challenge, with antiretroviral drug supply disruptions posing mortality and transmission risks.
  • Dolutegravir, an integrase strand transfer inhibitor, is crucial in combating HIV, known for its high resistance barrier in high-income settings.
  • Emerging reports of dolutegravir resistance in resource-limited settings necessitate an evaluation of its efficacy in these populations.

Purpose of the Study:

  • To review recent literature and conference communications on acquired drug resistance to dolutegravir in low- and middle-income countries.
  • To assess the prevalence and characteristics of dolutegravir resistance in resource-limited settings.
  • To identify factors associated with dolutegravir resistance and inform strategies for optimizing HIV treatment.

Main Methods:

  • Systematic literature search of published studies and conference abstracts.
  • Focus on acquired drug resistance to dolutegravir.
  • Inclusion of data from low- and middle-income countries.

Main Results:

  • Dolutegravir resistance primarily emerged in individuals with unsuppressed viral loads and adherence challenges.
  • Population-level resistance rates remained below 1% despite structural barriers.
  • The R263K substitution was common, and re-suppression with dolutegravir was often possible.
  • Minor programmatic adjustments could enhance outcomes.

Conclusions:

  • Dolutegravir maintains a high barrier to resistance in low-income countries, even with adherence issues.
  • Continued emphasis on treatment adherence support is vital.
  • Maintaining robust antiretroviral drug supply chains is critical for sustained HIV treatment success.