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. 2019 Aug 21;6(10):ofz377.
doi: 10.1093/ofid/ofz377. Online ahead of print.

Resistance in patients failing integrase strand transfer inhibitors: a call to replace raltegravir with dolutegravir in third-line treatment in South Africa

Kim Steegen  1   2 , Gert van Zyl  2   3 , Esrom Letsoalo  1   2 , Mathilda Claassen  2   3 , Lucia Hans  1   2 , Sergio Carmona  1   2
Affiliations

Resistance in patients failing integrase strand transfer inhibitors: a call to replace raltegravir with dolutegravir in third-line treatment in South Africa

Kim Steegen et al. Open Forum Infect Dis. .

Abstract

Data on integrase resistance patterns in low- and middle-income countries (LMICs) is scarce. We assessed genotypic drug resistance in 43 patients with virological failure on integrase strand transfer inhibitors (INSTIs) containing regimens as part of the third-line treatment program in South Africa. Of the raltegravir (RAL) exposed patients 20/34 (59%) had ≥1 major INSTI mutation, including two (6%) with dolutegravir (DTG) cross-resistance. DTG resistance was detected in one out of four DTG-exposed patients. Replacing RAL with DTG may reduce the risk of INSTI mutations. We recommend DTG drug resistance monitoring when DTG is introduced at a larger scale in LMICs.

Keywords: HIV-1 antiretroviral drug resistance; INSTI-based treatment failure; South Africa; dolutegravir; raltegravir.

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Figures

Figure 1.
Figure 1.
Flow-chart of patients failing integrase strand transfer inhibitor (INSTI)-based treatment in South Africa. *, For patients with ≥1 genotype request, only the most recent result was included. ¥, Three of 34 patients had been exposed to raltegravir (RAL) in the past but have no record on INSTI exposure at time of genotyping. ART, antiretroviral treatment; DTG, dolutegravir; EVG, elvitegravir.
See this image and copyright information in PMC

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