Journal of acquired immune deficiency syndromes (1999) · 2025
HIV Drug Resistance to Dolutegravir Among Adults Investigated for Antiretroviral Treatment Failure in Malawi: A 2023 National Cross-Sectional Survey.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Kalata Newton L, Bello George, Pals Sherri, Kabaghe Alinune N, Mkungudza Jonathan, Bighignoli Barbara, Panja Louis, Bilaal Wilson, Kusakale Grace, Chitenje Moses, Luhanga Misheck, Zeh Clement, Kampira Elizabeth, Chipeta Sikhona, Mvula Bernard, Nyirenda Rose, Jahn Andreas, Kagoli Matthews, Maida Alice, O'Malley Gabrielle, van Oosterhout Joep J, Agyemang Elfriede, Zheng Du-Ping, Hackett Stephanie, Raizes Elliot, Wadonda Nellie, da Silva Juliana
Аннотация
INTRODUCTION: In Malawi, 95.6% of adult people living with HIV (PLHIV) on antiretroviral therapy (ART) use dolutegravir-based regimens (DBR), however, prevalence of dolutegravir resistance is unknown. We conducted a national HIV drug resistance (HIVDR) survey in adults on DBR with high viral load (VL) results after intensive adherence counseling (IAC).
METHODS: The survey was conducted between July 2022 and February 2023. We randomly selected 18 from 25 highest volume ART clinics in Malawi. We enrolled consenting adults (≥15 years), on DBR for ≥9 months, when returning for follow-up VL testing after a previous high VL (≥1000 copies/mL) and completing IAC. Enrolled PLHIV submitted plasma samples for VL testing and those with VL ≥1000 copies/mL (confirmed virologic failure) underwent genotypic HIVDR testing. Stanford University HIVDR Database (version 9.5) was used to interpret results. We present weighted prevalence of clinically significant HIV drug resistance (Stanford levels 3-5), accounting for correlation within clinics.
RESULTS: Among 213 participants with confirmed virologic failure, 212 samples were successfully genotyped for protease, reverse transcriptase, and integrase. Prevalence of drug resistance mutations (DRMs) to nucleotide reverse-transcriptase inhibitors was 22.6% (95% CI: 17.4% to 27.8%), to non-nucleoside reverse-transcriptase inhibitors 55.1% (95% CI 48.2% to 62.1%), and to protease inhibitors 4.9% (95% CI 1.3% to 8.5%). Prevalence of major dolutegravir DRMs was 8.5% (95% CI 5.3% to 11.9%). DTG DRMs identified included G118R (8), E138K (8), R263K/A (5), Q148R (3), and T66A/I/V (3).
CONCLUSIONS: Among adult Malawians on DBRs with confirmed virologic failure, 1-in-12 had dolutegravir resistance. Adherence interventions likely help achieve resuppression, making protease inhibitor-based regimen switch unnecessary for most patients with high VL.
METHODS: The survey was conducted between July 2022 and February 2023. We randomly selected 18 from 25 highest volume ART clinics in Malawi. We enrolled consenting adults (≥15 years), on DBR for ≥9 months, when returning for follow-up VL testing after a previous high VL (≥1000 copies/mL) and completing IAC. Enrolled PLHIV submitted plasma samples for VL testing and those with VL ≥1000 copies/mL (confirmed virologic failure) underwent genotypic HIVDR testing. Stanford University HIVDR Database (version 9.5) was used to interpret results. We present weighted prevalence of clinically significant HIV drug resistance (Stanford levels 3-5), accounting for correlation within clinics.
RESULTS: Among 213 participants with confirmed virologic failure, 212 samples were successfully genotyped for protease, reverse transcriptase, and integrase. Prevalence of drug resistance mutations (DRMs) to nucleotide reverse-transcriptase inhibitors was 22.6% (95% CI: 17.4% to 27.8%), to non-nucleoside reverse-transcriptase inhibitors 55.1% (95% CI 48.2% to 62.1%), and to protease inhibitors 4.9% (95% CI 1.3% to 8.5%). Prevalence of major dolutegravir DRMs was 8.5% (95% CI 5.3% to 11.9%). DTG DRMs identified included G118R (8), E138K (8), R263K/A (5), Q148R (3), and T66A/I/V (3).
CONCLUSIONS: Among adult Malawians on DBRs with confirmed virologic failure, 1-in-12 had dolutegravir resistance. Adherence interventions likely help achieve resuppression, making protease inhibitor-based regimen switch unnecessary for most patients with high VL.