{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T11:58:23Z","timestamp":1791287903989,"version":"4.3.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2024,4,3]],"date-time":"2024-04-03T00:00:00Z","timestamp":1712102400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001711","name":"Swiss National Science Foundation","doi-asserted-by":"publisher","award":["PCEFP3_181355"],"award-info":[{"award-number":["PCEFP3_181355"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001711","name":"Swiss National Science Foundation","doi-asserted-by":"publisher","award":["IZ07Z0_160876\/1"],"award-info":[{"award-number":["IZ07Z0_160876\/1"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008375","name":"University of Basel","doi-asserted-by":"publisher","award":["3ZX1404"],"award-info":[{"award-number":["3ZX1404"]}],"id":[{"id":"10.13039\/100008375","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011318","name":"Fondation Botnar","doi-asserted-by":"publisher","award":["REG-19-008"],"award-info":[{"award-number":["REG-19-008"]}],"id":[{"id":"10.13039\/501100011318","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011318","name":"Fondation Botnar","doi-asserted-by":"publisher","award":["3ZX1422"],"award-info":[{"award-number":["3ZX1422"]}],"id":[{"id":"10.13039\/501100011318","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,11,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Since 2019, the World Health Organization has recommended dolutegravir-based antiretroviral therapy (ART) as the preferred regimen for human immunodeficiency virus management. Large-scale programmatic transitioning to dolutegravir-based ART was subsequently implemented across Africa, often in the absence of recent viral load testing and without access to genotypic resistance testing (GRT) in case of viremia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This study assessed emerging dolutegravir resistance in the routine care of the Viral Load Cohort North-East Lesotho. We included pediatric and adult participants who changed from nonnucleoside reverse transcriptase inhibitor\u2013 to dolutegravir-based ART and had at least 1 viral load assessment before and after the change. We sequenced available samples of participants fulfilling the additional virological criteria of having 2 viremic episodes while taking dolutegravir, with at least 1 viral load \u2265500\u2005copies\/mL taken \u226518 months after changing to dolutegravir.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 15 349 participants, 157 (1.0%) met the virological criteria, and GRT was successful for 85 (0.6%). Among these 85, 8 (9.4%) had dolutegravir resistance, with 2 (2.4%) and 6 (7.1%) predicted to have intermediate- and high-level dolutegravir resistance, respectively. One participant had 2, 2 had 1, and 5 had 0 active drugs in their regimen. A GRT from before the change to dolutegravir was available for 5 of these 8 participants: 4 had 0 and 1 had 1 active drug in their nonnucleoside transcriptase inhibitor\u2013based regimen.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Nine percent of people with persistent or recurring human immunodeficiency virus viremia \u226518 months after changing to dolutegravir-based ART had dolutegravir resistance. Detection and management of emerging dolutegravir resistance must be addressed across Africa.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciae185","type":"journal-article","created":{"date-parts":[[2024,4,3]],"date-time":"2024-04-03T11:33:42Z","timestamp":1712144022000},"page":"1208-1222","source":"Crossref","is-referenced-by-count":38,"title":["Emergence of Acquired Dolutegravir Resistance in Treatment-experienced People With HIV in Lesotho"],"prefix":"10.1093","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7303-9542","authenticated-orcid":false,"given":"Nadine","family":"Tschumi","sequence":"first","affiliation":[{"name":"Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel , Basel ,","place":["Switzerland"]},{"name":"Department of Clinical Research, University of Basel , Basel ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5373-4747","authenticated-orcid":false,"given":"Blaise","family":"Lukau","sequence":"additional","affiliation":[{"name":"SolidarMed, Partnerships for Health , Maseru ,","place":["Lesotho"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3948-5143","authenticated-orcid":false,"given":"Katleho","family":"Tlali","sequence":"additional","affiliation":[{"name":"SolidarMed, Partnerships for Health , Maseru ,","place":["Lesotho"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lipontso","family":"Motaboli","sequence":"additional","affiliation":[{"name":"SolidarMed, Partnerships for Health , Maseru ,","place":["Lesotho"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mpho","family":"Kao","sequence":"additional","affiliation":[{"name":"SolidarMed, Partnerships for Health , Maseru ,","place":["Lesotho"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathebe","family":"Kopo","sequence":"additional","affiliation":[{"name":"SolidarMed, Partnerships for Health , Maseru ,","place":["Lesotho"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7771-8608","authenticated-orcid":false,"given":"Kathrin","family":"Haenggi","sequence":"additional","affiliation":[{"name":"Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel , Basel ,","place":["Switzerland"]},{"name":"Department of Clinical Research, University of Basel , Basel ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moleboheng","family":"Mokebe","sequence":"additional","affiliation":[{"name":"SolidarMed, Partnerships for Health , Maseru ,","place":["Lesotho"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2722-6021","authenticated-orcid":false,"given":"Klaudia","family":"Naegele","sequence":"additional","affiliation":[{"name":"Clinical Virology, Laboratory Medicine, University Hospital Basel ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1051-5684","authenticated-orcid":false,"given":"Irene","family":"Ayakaka","sequence":"additional","affiliation":[{"name":"SolidarMed, Partnerships for Health , Maseru ,","place":["Lesotho"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5654-9356","authenticated-orcid":false,"given":"Karoline","family":"Leuzinger","sequence":"additional","affiliation":[{"name":"Clinical Virology, Laboratory Medicine, University Hospital Basel ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1874-6153","authenticated-orcid":false,"given":"Jennifer A","family":"Brown","sequence":"additional","affiliation":[{"name":"Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel , Basel ,","place":["Switzerland"]},{"name":"Department of Clinical Research, University of Basel , Basel ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3599-1791","authenticated-orcid":false,"given":"Niklaus D","family":"Labhardt","sequence":"additional","affiliation":[{"name":"Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel , Basel ,","place":["Switzerland"]},{"name":"Department of Clinical Research, University of Basel , Basel 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analysis","volume":"18","author":"Gupta","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"2024112123521848900_ciae185-B8","volume-title":"Update of recommendations on first-and second-line antiretroviral regimens","author":"WHO","year":"2019"},{"key":"2024112123521848900_ciae185-B9","volume-title":"Addendum to the national guidelines on the use of antiretroviral therapy for HIV prevention and treatment","author":"Ministry of Health","year":"2019"},{"key":"2024112123521848900_ciae185-B10","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1097\/QAI.0000000000003065","article-title":"Brief report: virologic impact of the dolutegravir transition: prospective results from the multinational African cohort study","volume":"91","author":"Esber","year":"2022","journal-title":"J Acquir Immune Defic Syndr"},{"key":"2024112123521848900_ciae185-B11","doi-asserted-by":"crossref","first-page":"e544","DOI":"10.1016\/S2352-3018(22)00136-9","article-title":"Viral suppression and HIV-1 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Management of HIV in Adults, Pregnancy and Breastfeeding, Adolescents, Children, Infants and Neonates","author":"Republic of South Africa National Department of Health","year":"2023"},{"key":"2024112123521848900_ciae185-B15","volume-title":"National guidelines on the use of antiretroviral therapy for HIV prevention and treatment. 6th ed.","author":"Ministry of Health","year":"2022"},{"key":"2024112123521848900_ciae185-B16","doi-asserted-by":"crossref","first-page":"e381","DOI":"10.1016\/S2352-3018(22)00092-3","article-title":"Efficacy and safety of dolutegravir or darunavir in combination with lamivudine plus either zidovudine or tenofovir for second-line treatment of HIV infection (NADIA): week 96 results from a prospective, multicentre, open-label, factorial, randomised, non-inferiority trial","volume":"9","author":"Paton","year":"2022","journal-title":"Lancet 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Chemother"},{"key":"2024112123521848900_ciae185-B19","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1093\/jac\/dkad010","article-title":"Emerging integrase strand transfer inhibitor drug resistance mutations among children and adults on ART in Tanzania: findings from a national representative HIV drug resistance survey","volume":"78","author":"Kamori","year":"2023","journal-title":"J Antimicrob Chemother"},{"key":"2024112123521848900_ciae185-B20","doi-asserted-by":"crossref","first-page":"ofac148","DOI":"10.1093\/ofid\/ofac148","article-title":"Dolutegravir resistance in Malawi's national HIV treatment program","volume":"9","author":"van Oosterhout","year":"2022","journal-title":"Open Forum Infect Dis"},{"key":"2024112123521848900_ciae185-B21","author":"World Health Organization"},{"key":"2024112123521848900_ciae185-B22","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1093\/cid\/ciab1006","article-title":"Viral load status before switching to dolutegravir-containing antiretroviral therapy and associations with human immunodeficiency virus treatment outcomes in Sub-Saharan Africa","volume":"75","author":"Romo","year":"2022","journal-title":"Clin Infect Dis"},{"key":"2024112123521848900_ciae185-B23","doi-asserted-by":"publisher","article-title":"Cohort profile: the Viral Load Cohort North-East Lesotho (VICONEL) from 2016 to 2022\u2014cohort description, test volumes, predictors of viraemia, and the road ahead","author":"Brown","DOI":"10.1101\/2024.03.12.24304025"},{"key":"2024112123521848900_ciae185-B24","doi-asserted-by":"crossref","first-page":"e684","DOI":"10.1016\/S2352-3018(23)00173-X","article-title":"Checklist for studies of HIV drug resistance prevalence or incidence: rationale and recommended use","volume":"10","author":"Mbuagbaw","year":"2023","journal-title":"Lancet 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