“Recent Study Reveals Surge in HIV Drug Resistance to Dolutegravir”

Naveed Babar Dar:

Lahore: The latest HIV Drug Resistance (HIVDR) Report from the World Health Organization (WHO) sheds light on the evolving landscape of drug resistance and offers critical insights for global health initiatives.

While there’s encouraging news regarding high levels of HIV viral load suppression (>90%) among populations receiving dolutegravir (DTG)-containing antiretroviral therapy (ART), there are also concerns. Observational data suggests that levels of HIVDR to DTG are surpassing those observed in clinical trials. Despite DTG’s efficacy and fewer side effects, resistance levels ranged from 3.9% to 8.6%, reaching 19.6% among individuals transitioning to DTG-containing ART with high viral loads.

Dr. Meg Doherty, Director of WHO’s Global HIV, Hepatitis, and STI Programmes, stresses the urgency for enhanced vigilance in HIV care delivery quality. Standardized surveillance of HIV drug resistance is crucial for prevention and effective response.

Haiti reported concerning data on HIVDR among ART-naïve infants, highlighting the importance of managing viral loads in pregnant and breastfeeding women to prevent transmission.

Though most countries have adopted WHO recommendations for HIV treatment, progress towards Sustainable Development Goals (SDG) targets has stalled. Despite extensive adoption of DTG-based treatment, new infections and HIV-related deaths persist. Many countries struggle with programmatic quality indicators, including retention in care and viral load suppression.

Only a fraction of WHO focus countries conduct routine surveillance of HIVDR. WHO urges standardized surveillance to guide treatment guidelines and enhance treatment programmes.

Cases of resistance to integrase-strand transfer inhibitors (INSTIs) post-cabotegravir (CAB-LA) exposure raise concerns. WHO recommends CAB-LA rollout for pre-exposure prophylaxis (PrEP) with accompanying surveillance of drug resistance.

Monitoring quality-of-care indicators, including ART pick-up and ARV drug stock-outs, is vital for program success. Strengthening data reporting systems and local engagement are essential for optimizing service delivery and curbing HIV drug resistance.

Minimizing HIV drug resistance is integral to the broader fight against antimicrobial resistance, necessitating coordinated action across all sectors of society.

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