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Randomized Controlled Trial
. 2019 Feb 22;16(1):5.
doi: 10.1186/s12981-019-0220-8.

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

Sarah E Rutstein  1 , Jane S Chen  2 , Julie A E Nelson  3   4 , Samuel Phiri  5 , William C Miller  6 , Mina C Hosseinipour  3   7
Affiliations
Randomized Controlled Trial

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

Sarah E Rutstein et al. AIDS Res Ther. .

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.

Keywords: Acute HIV infection; Antiretroviral resistance; Dolutegravir; Malawi.

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