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AIDS Res Ther. 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.

Author information

1
Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA. srutstein@unc.edu.
2
Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA.
3
Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA.
4
Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, NC, USA.
5
Lighthouse Trust, Lilongwe, Malawi.
6
Department of Epidemiology, Ohio State University, Columbus, OH, USA.
7
UNC Project, Lilongwe, Malawi.

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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