Growing HIV Drug Resistance To Dolutegravir

Context:

As per World Health Organization’s (WHO) latest HIV Drug Resistance (HIVDR) Report, resistance to the antiretroviral drug dolutegravir (DTG) is increasing among HIV patients.

• Haiti was the only country to report data from a survey of HIVDR among antiretroviral therapy (ART) naïve infants or infants starting ART for the first time.

About Dolutegravir (DTG)

• Antiretroviral Drug: Dolutegravir (DTG), sold under the brand name Tivicay, is an antiretroviral medication used, together with other medication, to treat HIV/AIDS. 
• Preferred for HIV Treatment: Since 2018, WHO has recommended dolutegravir as the preferred first- and second-line HIV treatment due to its effectiveness, ease of use and minimal side effects. 

Key Highlights of the HIV Drug Resistance (HIVDR) Report:

• A Positive Development: 
• • High levels of HIV viral load suppression (>90 per cent) in populations receiving DTG containing antiretroviral therapy (ART).
  • Arising Concerns: 
  • High Number of Cases: The report revealed that the Sustainable Development Goal (SDG) targets are off track, with 1.3 million new HIV infections and 630,000 HIV-related deaths reported in 2022.
  • Evidence of Drug Resistance: The worrying evidence of resistance in individuals with unsuppressed viral load despite dolutegravir treatment.
    • Survey data from four sources indicate resistance levels ranging from 3.9-8.6%, reaching 19.6% among individuals with high viral loads who transitioned to DTG-containing antiretroviral therapy (ART).
  • Transmission to Infants: Haiti reported a unique case where an infant, born to a mother receiving DTG-based ART, showed resistance to DTG. 

Recommendations: 

• Regular Monitoring: Routine surveillance of HIVDR to track prevalence and patterns of resistance, critical for shaping treatment guidelines and improving programme quality. 
  • • Routine monitoring of quality-of-care indicators, including on-time ART pick-up and viral load testing coverage, are crucial for successful ART programmes.
  • Strengthening of Data Reporting Systems: To monitor and report quality-of-care indicators effectively. 
  • Quality Enhancement: Target lacking by the countries emphasizing the need for improved quality of treatment and care services.

News Source: Down to Earth

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