{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T15:39:27Z","timestamp":1790609967522,"version":"4.1.0"},"reference-count":21,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T00:00:00Z","timestamp":1779494400000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["GH002038"],"award-info":[{"award-number":["GH002038"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Malawi began transitioning children living with HIV (CLHIV) to dolutegravir\u2010based regimens (DBRs) in 2020, and 99.9% were on a DBR by September 2023. With nearly universal use of DBR, surveillance of HIV drug resistance (HIVDR) to dolutegravir is essential. We describe the prevalence and patterns of HIVDR among CLHIV on DBR with confirmed virological failure (viral load [VL] twice \u22651000 copies\/mL).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We randomly selected 19 of the 25 highest\u2010volume ART health facilities in Malawi for participant enrolment between July 2022 and February 2023. Enrolment criteria included CLHIV aged 2\u201314 years, on a DBR for \u22659 months and VL \u22651000 copies\/mL. Sanger HIVDR genotyping was performed if a repeat VL result post\u2010intensive adherence counselling was \u22651000 copies\/mL. The Stanford University HIVDR Database was used for drug resistance interpretation. We present weighted HIVDR prevalence estimates with 95% confidence limits accounting for correlation within clinics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 302 CLHIV enrolled, 133 (44%) had confirmed virological failure. The weighted prevalence of dolutegravir resistance among CLHIV with confirmed virological failure was 15.6% (95% CI: 7.1\u221224.0%), with the presence of major dolutegravir drug resistance mutations (DRMs) in 14.2% (95% CI: 4.8\u221223.6). The most common dolutegravir DRMs were R263K (\n                      <jats:italic>n<\/jats:italic>\n                      = 11) and G118R (\n                      <jats:italic>n<\/jats:italic>\n                      = 4). Weighted prevalence rates of resistance to nucleoside reverse transcriptase inhibitors (NRTIs), non\u2010nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors were 42.2%, 65.5% and 5.0%, respectively. Three children had HIVDR to all four drug classes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Dolutegravir resistance was found in nearly one in six Malawian CLHIV with confirmed virological failure on DBRs. This raises concerns for treatment options in this vulnerable population, given the coexistence of high prevalence of resistance to NRTIs and NNRTIs. These results point to the need for regular HIVDR surveillance and further research to guide genotyping prioritization and next\u2010line treatment strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.70108","type":"journal-article","created":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T07:25:38Z","timestamp":1779521138000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Emerging Dolutegravir Resistance Among Children on Antiretroviral Therapy With Virological Failure in Malawi: Results From a 2023 National Cross\u2010Sectional Survey"],"prefix":"10.1002","volume":"29","author":[{"given":"George","family":"Bello","sequence":"first","affiliation":[{"name":"Public Health Institute of Malawi Ministry of Health  Lilongwe Malawi"},{"name":"International Training and Education Centre for Health University of Washington  Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8517-1586","authenticated-orcid":false,"given":"Alinune N.","family":"Kabaghe","sequence":"additional","affiliation":[{"name":"Division of Global HIV &amp; TB U.S. Centers for Disease Control and Prevention  Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherri","family":"Pals","sequence":"additional","affiliation":[{"name":"Division of Global HIV &amp; TB U.S. Centers for Disease Control and Prevention  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Newton L.","family":"Kalata","sequence":"additional","affiliation":[{"name":"Division of Global HIV &amp; TB U.S. Centers for Disease Control and Prevention  Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Bighignoli","sequence":"additional","affiliation":[{"name":"Public Health Institute of Malawi Ministry of Health  Lilongwe Malawi"},{"name":"International Training and Education Centre for Health University of Washington  Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joep J.","family":"van Oosterhout","sequence":"additional","affiliation":[{"name":"Partners in Hope  Lilongwe Malawi"},{"name":"Division of Infectious Diseases David Geffen School of Medicine University of California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Mkungudza","sequence":"additional","affiliation":[{"name":"Public Health Institute of Malawi Ministry of Health  Lilongwe Malawi"},{"name":"International Training and Education Centre for Health University of Washington  Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elfriede","family":"Agyemang","sequence":"additional","affiliation":[{"name":"Division of Global HIV &amp; TB U.S. Centers for Disease Control and Prevention  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Du\u2010Ping","family":"Zheng","sequence":"additional","affiliation":[{"name":"Division of Global HIV &amp; TB U.S. Centers for Disease Control and Prevention  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis","family":"Panja","sequence":"additional","affiliation":[{"name":"International Training and Education Centre for Health University of Washington  Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilson Bilaal","family":"Matola","sequence":"additional","affiliation":[{"name":"Directorate of HIV Hepatitis and Syphilis Ministry of Health  Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moses","family":"Chitenje","sequence":"additional","affiliation":[{"name":"Public Health Institute of Malawi Ministry of Health  Lilongwe Malawi"},{"name":"International Training and Education Centre for Health University of Washington  Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Kampira","sequence":"additional","affiliation":[{"name":"Division of Global HIV &amp; TB U.S. Centers for Disease Control and Prevention  Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clement","family":"Zeh","sequence":"additional","affiliation":[{"name":"Division of Global HIV &amp; TB U.S. Centers for Disease Control and Prevention  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benard","family":"Mvula","sequence":"additional","affiliation":[{"name":"Public Health Institute of Malawi Ministry of Health  Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca","family":"Alvarez","sequence":"additional","affiliation":[{"name":"Division of Global HIV &amp; TB U.S. Centers for Disease Control and Prevention  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthews","family":"Kagoli","sequence":"additional","affiliation":[{"name":"Public Health Institute of Malawi Ministry of Health  Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wongani","family":"Mzumara","sequence":"additional","affiliation":[{"name":"Division of Global HIV &amp; TB U.S. Centers for Disease Control and Prevention  Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine R.","family":"Simon","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine Children's Foundation \u2013 Malawi  Lilongwe Malawi"},{"name":"Texas Children's Global Health Network Texas Children's Hospital  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ireen","family":"Namakhoma","sequence":"additional","affiliation":[{"name":"International Training and Education Centre for Health University of Washington  Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle","family":"O'Malley","sequence":"additional","affiliation":[{"name":"Department of Global Health University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sikhona","family":"Chipeta","sequence":"additional","affiliation":[{"name":"Public Health Institute of Malawi Ministry of Health  Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rose","family":"Nyirenda","sequence":"additional","affiliation":[{"name":"Directorate of HIV Hepatitis and Syphilis Ministry of Health  Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliana","family":"da Silva","sequence":"additional","affiliation":[{"name":"Division of Global HIV &amp; TB U.S. Centers for Disease Control and Prevention  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nellie","family":"Wadonda","sequence":"additional","affiliation":[{"name":"Division of Global HIV &amp; TB U.S. Centers for Disease Control and Prevention  Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"For Malawi HIV Drug Resistance Surveillance Team","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,23]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/hiv.13154"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(24)00155-3"},{"key":"e_1_2_14_4_1","unstructured":"L.Bernstein K.Brooke D.Collado et\u00a0al. Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection(2001)."},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01645-21"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofaf679"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkaf180"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000003744"},{"key":"e_1_2_14_9_1","unstructured":"Ministry of Health and Population Malawi Malawi Guidelines for Clinical Management of HIV in Children and Adults(2022).https:\/\/www.differentiatedservicedelivery.org\/wp\u2010content\/uploads\/Malawi\u2010Clinical\u2010HIV\u2010Guidelines\u20102022\u2010edition\u20105.pdf."},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.2174\/187152611795589663"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40471-021-00268-3"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiae260"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/v16030399"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(24)00183-9"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(23)00228-X"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciae261"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-023-08288-8"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaf204"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01217-12"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkac056"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.1128\/jvi.00335-24"},{"key":"e_1_2_14_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000004170"}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.70108","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jia2.70108","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.70108","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T22:07:00Z","timestamp":1783116420000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jia2.70108"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":21,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1002\/jia2.70108"],"URL":"https:\/\/doi.org\/10.1002\/jia2.70108","archive":["Portico"],"relation":{},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"value":"1758-2652","type":"print"},{"value":"1758-2652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]},"assertion":[{"value":"2025-08-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70108"}}