Resistance in Patients Failing Integrase Strand Transfer Inhibitors: A Call to Replace Raltegravir With Dolutegravir in Third-Line Treatment in South Africa. (21st August 2019)

• Record Type: Journal Article
• Authors: Steegen, Kim; Van Zyl, Gert; Letsoalo, Esrom; Claassen, Mathilda; Hans, Lucia; Carmona, Sergio
• Is Part Of: Open forum infectious diseases. Volume 6:Number 10(2019)
• Publication Date: 2019-08-21
• Subjects: dolutegravir -- HIV-1 antiretroviral drug resistance -- INSTI-based treatment failure -- raltegravir -- South Africa; Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofz377
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Data on integrase resistance patterns in low- and middle-income countries (LMICs) is scarce. We assessed genotypic drug resistance in 43 patients with virological failure on integrase strand transfer inhibitors (INSTIs) containing regimens as part of the third-line treatment program in South Africa. Of the raltegravir (RAL)-exposed patients 20 of 34 (59%) had ≥1 major INSTI mutation, including 2 (6%) with dolutegravir (DTG) cross-resistance. Dolutegravir resistance was detected in 1 of 4 DTG-exposed patients. Replacing RAL with DTG may reduce the risk of INSTI mutations. We recommend DTG drug resistance monitoring when DTG is introduced at a larger scale in LMICs. Abstract : Integrase strand transfer inhibitors (INSTI) are a key component of third-line antiretroviral drug regimens in people living with HIV in low and middle income countries. This study describes drug resistance profiles in patients failing INSTI-based third-line treatment in South Africa which has the largest third-line treatment program globally.