HIV-1 drug resistance among people living with HIV receiving dolutegravir-based anti-retroviral regimens in Uganda: a national laboratory-based survey using remnant viral load samples, 2022.

BACKGROUND AND OBJECTIVES

Uganda adopted dolutegravir as its preferred HIV treatment regimen in the national guidelines for treatment of HIV and AIDS in 2018. We conducted a survey to estimate dolutegravir resistance 4 years post-dolutegravir introduction in routine clinical settings. This was a cross-sectional survey to estimate the prevalence of HIV drug resistance (HIVDR) to dolutegravir among children and adults with viral non-suppression (VNS; ≥1000 copies/mL) receiving dolutegravir-based antiretroviral therapy for at least 9 months.

METHODS

We used remnant specimens from routine viral load monitoring stored at Central Public Health Laboratories during February-April 2022. Genotyping of the protease, reverse transcriptase and integrase regions of the HIV-1 pol gene was done using Thermo Fisher® kits and analysed using the Stanford HIVDR database. Weighted prevalences of HIVDR with 95% confidence intervals (CI) were estimated for adults (≥15 years) and children (0-14 years).

RESULTS

We randomly selected 857 specimens including 457 from adults and 400 from children for HIVDR testing from 3578 eligible specimens collected during February-April 2022. Five hundred and eleven (59.6%) were successfully genotyped in the integrase region. Intermediate- to high-level dolutegravir HIVDR prevalence was 3.9% (CI: 0.7, 7.1) for adults and 6.6% (CI: 3.5, 9.6) for children.

CONCLUSION

HIVDR to dolutegravir was uncommon but present among both children and adults with VNS after 9 months or more of exposure to dolutegravir. Additional longitudinal outcomes data are needed to determine if adherence counselling for patients with VNS on dolutegravir regimens might improve outcomes.