{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T06:02:48Z","timestamp":1787896968857,"version":"build-2784847793"},"reference-count":30,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,12,23]],"date-time":"2023-12-23T00:00:00Z","timestamp":1703289600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"PEPFAR, through USAID and CDC"},{"name":"MHIRST-Fogarty internship grant"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Millions of Africans are on dolutegravir-based antiretroviral therapy (ART), but few detailed descriptions of dolutegravir resistance and its clinical management exist. We reviewed HIV drug resistance (HIVDR) testing application forms submitted between June 2019 and October 2022, data from the national HIVDR database, and genotypic test results. We obtained standardized ART outcomes and virological results of cases with dolutegravir resistance, and explored associations with dolutegravir resistance among individuals with successful integrase sequencing. All cases were on two nucleoside reverse transcriptase inhibitors (NRTIs)\/dolutegravir, and had confirmed virological failure, generally with prolonged viremia. Among 89 samples with successful integrase sequencing, 24 showed dolutegravir resistance. Dolutegravir resistance-associated mutations included R263K (16\/24), E138K (7\/24), and G118R (6\/24). In multivariable logistic regression analysis, older age and the presence of high-level NRTI resistance were significantly associated with dolutegravir resistance. After treatment modification recommendations, four individuals (17%) with dolutegravir resistance died, one self-discontinued ART, one defaulted, and one transferred out. Of the 17 remaining individuals, 12 had follow-up VL results, and 11 (92%) were &lt;1000 copies\/mL. Twenty-four cases with dolutegravir resistance among 89 individuals with confirmed virological failure suggests a considerable prevalence in the Malawi HIV program. Successful management of dolutegravir resistance was possible, but early mortality was high. More research on the management of treatment-experienced individuals with dolutegravir resistance is needed.<\/jats:p>","DOI":"10.3390\/v16010029","type":"journal-article","created":{"date-parts":[[2023,12,24]],"date-time":"2023-12-24T20:44:15Z","timestamp":1703450655000},"page":"29","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Virological Findings and Treatment Outcomes of Cases That Developed Dolutegravir Resistance in Malawi\u2019s National HIV Treatment Program"],"prefix":"10.3390","volume":"16","author":[{"given":"Hope","family":"Kanise","sequence":"first","affiliation":[{"name":"Partners in Hope, Lilongwe P.O. Box 302, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joep J.","family":"van Oosterhout","sequence":"additional","affiliation":[{"name":"Partners in Hope, Lilongwe P.O. Box 302, Malawi"},{"name":"Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pachawo","family":"Bisani","sequence":"additional","affiliation":[{"name":"The Lighthouse Trust, Lilongwe P.O. Box 106, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Songo","sequence":"additional","affiliation":[{"name":"Partners in Hope, Lilongwe P.O. Box 302, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bilaal W.","family":"Matola","sequence":"additional","affiliation":[{"name":"Directorate of HIV, STI and Viral Hepatitis, Ministry of Health, Lilongwe P.O. Box 30377, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chifundo","family":"Chipungu","sequence":"additional","affiliation":[{"name":"Partners in Hope, Lilongwe P.O. Box 302, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Simon","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine Children\u2019s Foundation-Malawi, Lilongwe P.O. Box 110, Malawi"},{"name":"Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2818-8639","authenticated-orcid":false,"given":"Carrie","family":"Cox","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine Children\u2019s Foundation-Malawi, Lilongwe P.O. Box 110, Malawi"},{"name":"Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mina C.","family":"Hosseinipour","sequence":"additional","affiliation":[{"name":"University of North Carolina Project Malawi, Lilongwe Private Bag A-104, Malawi"},{"name":"Department of Medicine, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC 27599, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Batiste","family":"Sagno","sequence":"additional","affiliation":[{"name":"DREAM, Communion of St. Egidio, Blantyre, P.O. Box 30355, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Risa M.","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Wallrauch","sequence":"additional","affiliation":[{"name":"The Lighthouse Trust, Lilongwe P.O. Box 106, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9372-212X","authenticated-orcid":false,"given":"Sam","family":"Phiri","sequence":"additional","affiliation":[{"name":"Partners in Hope, Lilongwe P.O. Box 302, Malawi"},{"name":"School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe P.O. Box 30184, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3226-7685","authenticated-orcid":false,"given":"Kim","family":"Steegen","sequence":"additional","affiliation":[{"name":"Department of Haematology & Molecular Medicine, National Health Laboratory Service, Johannesburg 2131, South Africa"},{"name":"Department of Haematology & Molecular Medicine, University of the Witwatersrand, Johannesburg 2017, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Jahn","sequence":"additional","affiliation":[{"name":"Directorate of HIV, STI and Viral Hepatitis, Ministry of Health, Lilongwe P.O. Box 30377, Malawi"},{"name":"Department of Global Health, University of Washington, Seattle, WA 98195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rose","family":"Nyirenda","sequence":"additional","affiliation":[{"name":"Directorate of HIV, STI and Viral Hepatitis, Ministry of Health, Lilongwe P.O. Box 30377, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Heller","sequence":"additional","affiliation":[{"name":"The Lighthouse Trust, Lilongwe P.O. Box 106, Malawi"},{"name":"International Training and Education Center for Health (ITECH), University of Washington, Seattle, WA 98104-2499, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s12977-022-00608-1","article-title":"A clinical review of HIV integrase strand transfer inhibitors (INSTIs) for the prevention and treatment of HIV-1 infection","volume":"19","author":"Zhao","year":"2022","journal-title":"Retrovirology"},{"key":"ref_2","unstructured":"World Health Organization (2021). Consolidated Guidelines on HIV Prevention, Testing, Treatment, Service Delivery and Monitoring. Recommendations for a Public Health Approach, WHO. Available online: https:\/\/www.who.int\/publications-detail-redirect\/9789240031593."},{"key":"ref_3","unstructured":"World Health Organization (2021). 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