Despite increasing use of integrase inhibitors to treat HIV infection, resistance to this class remains stable.

BACKGROUND

The aim of this study was to evaluate changes in prevalence of resistance to integrase strand transfer inhibitors (INSTIs) in relation to changes in their use over 16 years in people living with HIV (PLWHIV) treated with antiretrovirals (ARVs) and in virological failure.

MATERIALS AND

METHODS

We analysed the use of different INSTIs (for ≥3 months during the study year) in ARV-treated PLWHIV in an academic centre and the HIV INSTI resistance profiles in RNA in case of virological failure (2008-24; analysed using the ANRS-MIE algorithm v33).

RESULTS

During the studied period (2008-24), INSTI use increased from 3.3% to 71.2%. Raltegravir use peaked at 21.5% in 2013 and then declined to 2.5% in 2024. Elvitegravir followed a similar trend, increasing to 15.7% in 2018 and then decreasing to 1.5% in 2024. Dolutegravir increased steadily from 6.3% in 2014 to 39.3% in 2023 and bictegravir from 2.0% in 2018 to 28.0% in 2024. Cabotegravir, first noted in 2020 (0.3%), will reach 3.8% in 2024. The proportion of patients with INSTI-resistant viruses was initially high for raltegravir (47.8% in 2008), before decreasing. By 2024, resistance was 2.7% for dolutegravir, cabotegravir and bictegravir, but remained higher for raltegravir (8.5%) and elvitegravir (9.8%).

CONCLUSIONS

Although the use of INSTIs has increased over time with differences in the duration of use, we did not observe a corresponding increase in the proportion of ARV-treated PLWHIV who experienced virological failure with INSTI-resistant viruses during the study period.