{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T17:20:47Z","timestamp":1772644847670,"version":"3.50.1"},"posted":{"date-parts":[[2026,3,2]]},"group-title":"HIV\/AIDS","reference-count":30,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,3,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>\n                    Maintaining viral suppression among people who inject drugs (\n                    <jats:bold>PWID<\/jats:bold>\n                    ) living with HIV in sub-Saharan Africa remains critical to minimize drug resistance for dolutegravir (\n                    <jats:bold>DTG<\/jats:bold>\n                    )-based regimens. We evaluated PWID taking DTG to assess longitudinal rates of viral non-suppression and emergence of drug resistance mutations in Kenya.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>\n                    We enrolled Kenyan PWID who had transitioned from an efavirenz (\n                    <jats:bold>EFV<\/jats:bold>\n                    ) based regimen to tenofovir+lamivudine+DTG (\n                    <jats:bold>TLD<\/jats:bold>\n                    ) \u22656 months prior, and measured plasma HIV RNA viral load (\n                    <jats:bold>VL<\/jats:bold>\n                    ) every 6 months for 2 years. We used univariable Cox proportional hazards to assess longitudinal risk for viremia (VL &gt;200 copies\/ml). Plasma specimens with viremia were genotyped for HIV drug resistance, including minority variants, using a lab-developed PacBio sequencing assay, and referenced by the Stanford HIVdb program.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 250 participants, 125 were receiving methadone, 199 (79.6) reported heroin use, 70% were male, and median age was 39 years. 194 (77.6%) participants completed all five study visits, 41 (16.4%) were lost to follow-up and 15 (6.0%) died. Across all study visits, 166 (66.0%) of the 250 participants were always suppressed, and 84 (33.6%) were viremic at least once during follow-up, including 8 (3.2%) who were always viremic and 76 (30.4%) who were intermittently suppressed. Living in an improvised shelter or outdoors was significantly associated with a higher risk of viremia (HR=4.35, 95% CI: 1.52\u201312.53). 93 specimens had drug resistance genotyping, 27 (29%) of which were from participants with incomplete follow-up. NNRTI resistance was frequent (37-41% across visits), whereas major resistance mutations were infrequent to tenofovir (4.3%), lamivudine (7.5%), and DTG (1%, minority variant S153F detected at 1% frequency). Accessory DTG mutations, which do not independently reduce susceptibility, were more common, observed in 41% (38\/93) of genotyped specimens, most often T97A, E138K, and L74M.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Among PWID living with HIV on TLD in Kenya, one-third had intermittent or sustained viral non-suppression across two years of follow-up. While NNRTI resistance was common, DTG resistance mutations were rare. Improving viral suppression among PWID living with HIV will reduce transmission risks and improve clinical outcomes.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.02.26.26347230","type":"posted-content","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T15:55:15Z","timestamp":1772466915000},"source":"Crossref","is-referenced-by-count":0,"title":["HIV viral non-suppression and drug resistance among persons who inject drugs on dolutegravir antiretroviral therapy in Kenya"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5916-7188","authenticated-orcid":false,"given":"Loice W.","family":"Mbogo","sequence":"first","affiliation":[{"name":"University of Washington Global Assistance Program-Kenya, Nairobi, Kenya"},{"name":"Division of Infectious Diseases Emory University School of Medicine and Department of Global Health, Emory University, Atlanta, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3716-8216","authenticated-orcid":false,"given":"Ceejay L.","family":"Boyce","sequence":"additional","affiliation":[{"name":"Center for Global Infectious Disease Research, Seattle Children\u2019s Research Institute, Seattle, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Betsy","family":"Sambai","sequence":"additional","affiliation":[{"name":"University of Washington Global Assistance Program-Kenya, Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3361-6026","authenticated-orcid":false,"given":"Stephen E.","family":"Hawes","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA"},{"name":"Department of Global Health, University of Washington, Seattle, USA School of Public Health and School of Medicine, University of Washington, Seattle, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brandon L.","family":"Guthrie","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA"},{"name":"Department of Global Health, University of Washington, Seattle, USA School of Public Health and School of Medicine, University of Washington, Seattle, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6898-207X","authenticated-orcid":false,"given":"William Sinkele D.","family":"Min","sequence":"additional","affiliation":[{"name":"National HIV and STI Control Programme (NASCOP), Kenya Ministry of Health, Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Kimani","sequence":"additional","affiliation":[{"name":"University of Washington Global Assistance Program-Kenya, Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent","family":"Adhanja","sequence":"additional","affiliation":[{"name":"University of Washington Global Assistance Program-Kenya, Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2125-6799","authenticated-orcid":false,"given":"Bhavna H.","family":"Chohan","sequence":"additional","affiliation":[{"name":"Department of Global Health, University of Washington, Seattle, USA School of Public Health and School of Medicine, University of Washington, Seattle, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3202-1650","authenticated-orcid":false,"given":"Robert A.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aliza","family":"Monroe-Wise","sequence":"additional","affiliation":[{"name":"Department of Global Health, University of Washington, Seattle, USA School of Public Health and School of Medicine, University of Washington, Seattle, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esther","family":"Gitau","sequence":"additional","affiliation":[{"name":"Support for Addictions Prevention and Treatment in Africa (SAPTA), Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Masyuko","sequence":"additional","affiliation":[{"name":"Department of Global Health, University of Washington, Seattle, USA School of Public Health and School of Medicine, University of Washington, Seattle, USA"},{"name":"National HIV and STI Control Programme (NASCOP), Kenya Ministry of Health, Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8409-4689","authenticated-orcid":false,"given":"Vincent C.","family":"Marconi","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Emory University School of Medicine and Department of Global Health, Emory University, Atlanta, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5749-481X","authenticated-orcid":false,"given":"Geoffrey S.","family":"Gottlieb","sequence":"additional","affiliation":[{"name":"Department of Global Health, University of Washington, Seattle, USA School of Public Health and School of Medicine, University of Washington, Seattle, USA"},{"name":"Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul K.","family":"Drain","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA"},{"name":"Department of Global Health, University of Washington, Seattle, USA School of Public Health and School of Medicine, University of Washington, Seattle, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa M.","family":"Frenkel","sequence":"additional","affiliation":[{"name":"Center for Global Infectious Disease Research, Seattle Children\u2019s Research Institute, Seattle, USA"},{"name":"Department of Global Health, University of Washington, Seattle, USA School of Public Health and School of Medicine, University of Washington, Seattle, USA"},{"name":"Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, USA"},{"name":"Department of Pediatrics, University of Washington, Seattle, USA"},{"name":"Department of Laboratory Medicine & Pathology, 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