Low-level viraemia despite emergence of dolutegravir-resistant variants.

Abstract

Dolutegravir (DTG), an integrase strand transfer inhibitor (INSTI)-based HIV-1 therapy, is widely recommended in first-line and second-line regimens.1,2 Integrase strand transfer inhibitor resistance mutations associated with DTG-containing regimens have been well described, most often occurring after DTG monotherapy or in INSTI-experienced patients.3Although rare, emergence of these mutations has also been described in patients on DTG-containing triple-drug regimens4 and INSTInaïve patients.5,6 The R263K mutation is commonly associated with the emergence of DTG resistance but reduces viral fitness and DNA integration.7,8 Here we describe a case of very slow viral decline (~42 months) in a treatment-experienced, INSTI-naïve patient on a DTG-based triple therapy regimen.