Emmanuel Ndashimye1, Eric J Arts2. 1. Department of Microbiology and Immunology, Western University, London, Canada; Joint Clinical Research Centre, Center for AIDS Research Uganda Laboratories, Kampala, Uganda. Electronic address: endashim@uwo.ca. 2. Department of Microbiology and Immunology, Western University, London, Canada. Electronic address: earts@uwo.ca.
Abstract
BACKGROUND: Dolutegravir (DTG) is now recommended to all HIV infected adults, adolescents, and children of right age by WHO. The low cost of $75 per year for generic DTG-based combination, has allowed 3.9 million people living with HIV (PLWH) in low and middle-income countries (LMICs) access to DTG. Lamivudine and emtricitabine associated M184V/I mutation is highly prevalent in PLWH and the majority of HIV infected individuals receiving DTG regimens may already be carrying M184V/I mutation. DISCUSSION: Despite high prevalence of M184V/I in antiretroviral therapy (ART) experienced patients, DTG treatment outcomes will likely not be adversely affected by this mutation. The use of DTG in ART naïve has been largely characterised by rare emergence of resistance and virological failure. DTG-based regimens have to great extent been effective at maintaining viral suppression in treatment experienced PLWH carrying M184V/I. CONCLUSIONS: Initiating patients on DTG may help preserve more treatment options for HIV infected individuals living in LMICs. High genetic barrier to the development of resistance associated with DTG and progressive viral suppression in patients switched to DTG-based therapy with M184V/I, may encourage better DTG outcomes and help in curbing increasing levels of HIV drug resistance in LMICs.
BACKGROUND:Dolutegravir (DTG) is now recommended to all HIV infected adults, adolescents, and children of right age by WHO. The low cost of $75 per year for generic DTG-based combination, has allowed 3.9 million people living with HIV (PLWH) in low and middle-income countries (LMICs) access to DTG. Lamivudine and emtricitabine associated M184V/I mutation is highly prevalent in PLWH and the majority of HIV infected individuals receiving DTG regimens may already be carrying M184V/I mutation. DISCUSSION: Despite high prevalence of M184V/I in antiretroviral therapy (ART) experienced patients, DTG treatment outcomes will likely not be adversely affected by this mutation. The use of DTG in ART naïve has been largely characterised by rare emergence of resistance and virological failure. DTG-based regimens have to great extent been effective at maintaining viral suppression in treatment experienced PLWH carrying M184V/I. CONCLUSIONS: Initiating patients on DTG may help preserve more treatment options for HIV infected individuals living in LMICs. High genetic barrier to the development of resistance associated with DTG and progressive viral suppression in patients switched to DTG-based therapy with M184V/I, may encourage better DTG outcomes and help in curbing increasing levels of HIV drug resistance in LMICs.
Authors: Anna Maria Geretti; Jose Luis Blanco; Anne Genevieve Marcelin; Carlo Federico Perno; Hans Jurgen Stellbrink; Dan Turner; Tuba Zengin Journal: Infect Dis Ther Date: 2022-08-01
Authors: Paul E Oluniyi; Fehintola V Ajogbasile; Shuntai Zhou; Iyanuoluwa Fred-Akintunwa; Christina S Polyak; Julie A Ake; Sodsai Tovanabutra; Michael Iroezindu; Morgane Rolland; Christian T Happi Journal: AIDS Date: 2022-01-01 Impact factor: 4.632