WHO: New report documents increase in HIV drug resistance to dolutegravir

The World Health Organization’s (WHO) latest HIV Drug Resistance (HIVDR) Report tells us where drug resistance is growing and offers recommendations for countries to monitor and respond to the potential challenges.

The report shares some good news and some concerning news. It highlights high levels of HIV viral load suppression (>90%) in populations receiving dolutegravir (DTG)-containing antiretroviral therapy (ART). However, observational and country-generated survey data indicate that levels of HIVDR to DTG are exceeding levels observed in clinical trials.

Since 2018, WHO has recommended use of dolutegravir as the preferred first- and second-line HIV treatment for all population groups. It is more effective, easier to take, and has fewer side effects than other drugs currently in use. It also has a high genetic barrier to developing drug resistance.

However, among the four surveys reported, levels of resistance to dolutegravir ranged from 3.9% to 8.6%, and reached 19.6% among people experienced with treatment and transitioned to a DTG-containing ART while having high HIV viral loads. To date, only a few countries have reported survey data to WHO.

“The worrying evidence of resistance in individuals with unsuppressed viral load despite dolutegravir treatment underscores the necessity for increased vigilance and intensified efforts to optimize the quality of HIV care delivery,” said Dr Meg Doherty, Director, WHO Department of the Global HIV, Hepatitis and STI Programmes. “Standardized surveillance of HIV drug resistance is essential for effectively preventing, monitoring, and responding to these challenges”.

Haiti was the only country to report data from a survey of HIVDR among ART naïve infants or infants starting ART for the first time. One infant, whose mother had received DTG-based ART, was found to have DTG resistance.  Effective management of high viral loads among pregnant and breastfeeding women is critical to prevent transmitting HIV to infants. Increasing routine surveillance for HIVDR among infants newly diagnosed with HIV not yet taking HIV treatment will be important to guide appropriate ART options for the future

Additional information to the following link: https://www.who.int/news/item/05-03-2024-new-report-documents-increase-in-hiv-drug-resistance-to-dolutegravir