High Rates of Transmitted NNRTI Resistance Among Persons with Acute HIV Infection in Malawi: Implications for First-line Dolutegravir Scale-up

Overview

Journal AIDS Res Ther

Publisher Biomed Central

Specialty Infectious Diseases

Date 2019 Feb 24

PMID 30795780

Citations 11

Authors

Sarah E Rutstein

Jane S Chen

Julie A E Nelson

Samuel Phiri

William C Miller

Mina C Hosseinipour

Affiliations

Soon will be listed here.

Abstract

High rates of non-nucleoside reverse transcriptase inhibitors (NNRTI) resistance was a key consideration in the WHO policies transitioning first-line regimens to include integrase inhibitors (dolutegravir [DTG]). However, recent data suggests a relationship between DTG and neural tube defects among women exposed during conception, giving providers and policymakers pause regarding the planned regimen changes. We examined HIV drug resistance among a cohort of 46 acutely infected persons in Malawi. Our data demonstrates high levels of transmitted resistance, 11% using standard resistance surveillance mutations and 20% when additional NNRTI polymorphisms that may affect treatment response are included. High resistance rates in this treatment-naïve patient population reinforces the critical nature of DTG-based options in the context of public-health driven treatment programs.

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