High rates of transmitted NNRTI resistance among persons with acute HIV infection in Malawi: implications for first-line dolutegravir scale-up.

AIDS Res Ther 2019 Feb 22;16(1). Epub 2019 Feb 22.

Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA.

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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Source
http://dx.doi.org/10.1186/s12981-019-0220-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6385432PMC
February 2019
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