Emergence of Acquired HIV Drug Resistance Among Individuals Receiving Dolutegravir-Based Antiretroviral Therapy in Uganda: A National Laboratory-Based Survey 2023

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Abstract Background As dolutegravir (DTG)-based regimens (DBRs) become more widely used and patients remain on treatment longer, cases of virological failure remain rare. This study presents findings from the second annual round of acquired HIV drug resistance (HIVDR) surveillance in Uganda, among individuals with viral nonsuppression (≥1000 copies/mL) receiving DBRs for ≥9 months. The first round was conducted from February to April 2022. Methods This nationally representative cross-sectional survey analyzed randomly selected remnant plasma and dried blood spot specimens collected between April and July 2023 from the Central Public Health Laboratories. Genotyping targeted the integrase, protease, and reverse transcriptase regions of the HIV-1 pol gene, resistance was analyzed using the Stanford HIVDR Database. Weighted HIVDR prevalence and 95% confidence intervals (CIs) were calculated for children (0–14 years) and adults (≥15 years). Results Out of 857 specimens tested, 400 (46.7%) were from children and 457 (53.3%) from adults. Median ages were 11 years for children and 36 years for adults. Median time on DBRs was 1.9 years for children and 2.4 years for adults. Five hundred and fifty-nine (65.2%) specimens were successfully genotyped. The prevalence of DTG resistance was 10.1% (95% CI: 6.4%–13.9%) in children and 8.6% (95% CI: 3.9%–13.3%) in adult, higher than the first round with a prevalence of 6.6% (95% CI: 3.5%–9.6%) and 4.4% (95% CI: 0.7%–7.1%), respectively Conclusions The increase in DTG resistance among both children and adults highlights the need to strengthen adherence and enhance early identification of individuals at risk of HIVDR through novel and existing programmatic interventions.

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