Mutations associated with viral resistance to integrase in individuals initiating dolutegravir-containing antiretroviral therapy: retrospective cohort, Brazil 2017-2019.

Abstract

Retrospective cohort aimed to analyze viral resistance mutations to integrase in people living with HIV/Aids (PLWHA) in Brazil. Patients receiving first-line therapy with a three-drug antiretroviral (ART) regimen containing dolutegravir (DTG), with HIV-1 genotypic resistance test available after starting treatment, were included. Data from three national databases related to antiretroviral dispensing, LT CD4+ cell count and HIV viral load (VL), and genotyping resistance testing were linked. Ideal adherence was defined as the proportion of days covered (PDC) ≥ 80%. Thirty (7.0%) of the 430 participants had resistance to DTG; five had high and 11 had moderate resistance levels. The N155H (n = 9) and E138K (n = 7) mutations were the most prevalent. DTG mutations were significantly more prevalent among males, whites, and those with HIV-VL count > 100,000 copies/mL, switching to alternative regimens or with resistance mutations to other classes of antiretroviral drugs (p < 0.05). Ideal ART adherence was observed in 52.8% of the participants and it was associated with DTG mutations (p < 0.001). This study described the resistance mutations to DTG in individuals starting treatment with this drug and the characteristics of such individuals. Understanding such a profile is crucial to regions where a DTG-containing regimen is the recommended first-line therapy.