Emergence of Acquired HIV Drug Resistance Among Individuals Receiving Dolutegravir-Based Antiretroviral Therapy in Uganda: A National Laboratory-Based Survey 2023 - Report - MDSpire
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Rise of Acquired Resistance to HIV Medications in Patients on Dolutegravir-Based Antiretroviral Therapy in Uganda: Findings from a 2023 National Laboratory Survey
Rise of Acquired Resistance to Dolutegravir in Ugandan Patients on ART
Overview
A 2023 national survey in Uganda found an increase in dolutegravir (DTG) resistance among patients on DTG-based regimens (DBRs) with viral nonsuppression. DTG resistance prevalence rose to 10.1% in children and 8.6% in adults, higher than the previous 2022 survey, highlighting emerging challenges in HIV treatment.
Background
Dolutegravir, a second-generation integrase strand transfer inhibitor, is widely used globally due to its efficacy and high resistance barrier. Uganda transitioned to DTG-based regimens starting in 2018, achieving viral load suppression rates above 90%. Despite high suppression rates, cases of virological failure and acquired drug resistance are emerging, necessitating ongoing surveillance to guide treatment strategies.
Data Highlights
Parameter
Children (0–14 years)
Adults (≥15 years)
Specimens tested
400
457
Median age (years)
11
36
Median time on DBRs (years)
1.9
2.4
Specimens successfully genotyped
559 (65.2% overall)
DTG resistance prevalence (2023)
10.1% (95% CI: 6.4%–13.9%)
8.6% (95% CI: 3.9%–13.3%)
DTG resistance prevalence (2022)
6.6% (95% CI: 3.5%–9.6%)
4.4% (95% CI: 0.7%–7.1%)
Key Findings
DTG resistance prevalence increased from 6.6% to 10.1% in children and from 4.4% to 8.6% in adults between 2022 and 2023.
Among 857 specimens tested, 65.2% were successfully genotyped for HIV drug resistance mutations.
Median duration on DTG-based regimens was approximately 2 years for both children and adults.
Viral load suppression in Uganda remains high at 94% among those on DBRs despite emerging resistance.
Resistance surveillance used nationally representative sampling and standardized genotyping methods targeting integrase, protease, and reverse transcriptase regions.
Clinical Implications
The rising prevalence of DTG resistance underscores the importance of strengthening adherence support and early detection of treatment failure. Routine HIV drug resistance surveillance should be integrated into ART programs to promptly identify and manage individuals at risk. These measures are critical to sustaining the effectiveness of DTG-based regimens in Uganda and similar settings.
Conclusion
This national survey reveals a concerning increase in acquired resistance to dolutegravir among patients with viral nonsuppression in Uganda. Enhanced programmatic interventions are needed to mitigate resistance development and preserve treatment efficacy.
References
Uganda National Laboratory Survey 2023 -- Rise of Acquired Resistance to HIV Medications
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