Emergence of Acquired HIV Drug Resistance Among Individuals Receiving Dolutegravir-Based Antiretroviral Therapy in Uganda: A National Laboratory-Based Survey 2023 - Scorecard - MDSpire
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Emergence of Acquired HIV Drug Resistance Among Individuals Receiving Dolutegravir-Based Antiretroviral Therapy in Uganda: A National Laboratory-Based Survey 2023
Clinical Scorecard: Rise of Acquired Resistance to HIV Medications in Patients on Dolutegravir-Based Antiretroviral Therapy in Uganda: Findings from a 2023 National Laboratory Survey
At a Glance
Category
Detail
Condition
HIV infection with acquired resistance to dolutegravir-based antiretroviral therapy
Key Mechanisms
Emergence of HIV drug resistance mutations in integrase, protease, and reverse transcriptase regions of HIV-1 pol gene leading to virological failure
Target Population
Children (0–14 years) and adults (≥15 years) on dolutegravir-based regimens for ≥9 months with viral nonsuppression (≥1000 copies/mL)
Care Setting
National HIV treatment programs and laboratory surveillance settings in Uganda
Key Highlights
Prevalence of dolutegravir resistance increased to 10.1% in children and 8.6% in adults in 2023, higher than 2022 estimates.
Dolutegravir-based regimens are widely used in Uganda with >97% of ART recipients on DBRs and viral suppression rates exceeding 90%.
Routine national surveillance using standardized methods (CADRE) is critical for early detection and management of acquired HIV drug resistance.
Guideline-Based Recommendations
Diagnosis
Perform viral load testing to identify viral nonsuppression (≥1000 copies/mL) in patients on dolutegravir-based regimens.
Conduct HIV drug resistance genotyping targeting integrase, protease, and reverse transcriptase regions for patients with viral nonsuppression.
Management
Strengthen adherence support interventions to reduce emergence of drug resistance.
Consider regimen switch or optimization guided by resistance profiles in patients with confirmed dolutegravir resistance.
Monitoring & Follow-up
Implement routine national surveillance of acquired HIV drug resistance using standardized cross-sectional survey methods (e.g., CADRE).
Monitor viral load suppression rates regularly to identify individuals at risk of resistance early.
Risks
Prolonged viral nonsuppression on dolutegravir-based regimens increases risk of acquired resistance.
Delayed identification of resistance may compromise treatment efficacy and increase transmission risk.
Patient & Prescribing Data
Children and adults on dolutegravir-based antiretroviral therapy in Uganda with viral nonsuppression
Median duration on dolutegravir-based regimens was approximately 1.9 years for children and 2.4 years for adults; resistance prevalence is rising despite high viral suppression rates overall.
Clinical Best Practices
Ensure high viral load testing coverage (>80%) among patients on ART to detect treatment failure promptly.
Use genotypic resistance testing to guide clinical decisions in patients with viral nonsuppression on dolutegravir-based regimens.
Enhance adherence counseling and support to prevent emergence of drug resistance.
Incorporate findings from national resistance surveillance into ART program planning and policy updates.
