The HIV epidemic continues to be a major global public health concern. According to the latest data from the World Health Organization (WHO), approximately 630,000 people globally died from HIV-related causes and 39.0 million people were living with HIV in 2022 [1]. For the past six years, the integrase inhibitor dolutegravir (DTG) has been the preferred antiretroviral (ARV) drug in first- and second-line regimens, and the WHO estimates that as of 2021, 22 million people in 110 countries living with HIV were receiving DTG-based treatment [2]. Recent research, however, suggests that DTG resistance is beginning to emerge, exceeding levels observed in clinical trials.
Are these indications of HIV drug resistance a cause for alarm? That is the central question asked—and answered—in the new webinar titled Update on Emerging HIV Drug Resistance to Integrase Inhibitors – How Concerned Should We Be? This information-packed session offers insights from three experts in HIV resistance, who discuss not only the implications of emerging resistance to DTG but also strategies to preserve the efficacy of available antiretroviral therapies.
Insights about HIV drug resistance from across Africa
The webinar opens with brief presentations by each of the three speakers:
| Speaker | Credentials |
| Bilaal Wilson Matola | MD, MPH, HIV Care and Treatment Program Officer, Department of HIV/AIDS, Ministry of Health, Malawi |
| Leonard Kingwara | MPH, PhD, Head, National Genomics and Molecular Surveillance Laboratory, National Public Health Institute, Kenya |
| Francois Venter | MD, FCP, PhD, Executive Director of Ezintsha, University of Witwatersrand, South Africa |
- Matola reviews the HIV drug resistance monitoring program in Malawi and shares new surveillance study results suggesting considerable emergent DTG resistance.
- Kingwara reports on a surveillance study in Kenya that found the risk of DTG resistance mutations may be higher in those with a background of pre-existing mutations. This study also emphasizes the importance of viral load and DTG resistance monitoring in people living with HIV who are on DTG-based treatments.
- Venter presents his insights framed by the question, “What keeps me up at night about ARV resistance in 2024?” He discusses the growing challenges to DTG regimens, as well as possible frameworks for solutions, including long-acting injectables.
Reasons for emerging DTG resistance, looking ahead to potential new HIV treatments, and more
During the webinar, the three individual presentations are followed by an engaging panel discussion moderated by Obiageli Okafor, MD, DrPH, MPH, Senior Manager, Product Applications, at Thermo Fisher Scientific. During this segment, the speakers provided details on the implications of emerging HIV drug resistance at both the population- and individual-health levels.
Importantly, with medication non-adherence as the most likely source of emerging DTG resistance, the speakers covered strategies for addressing poor patient compliance with treatment regimens. In addition, the panel discussed the need to build consensus around the definition of low-level viremia, the utility of clinical-level data vs. surveillance data, the importance of developing locally appropriate and sustainable solutions, and the role of genotyping-guided treatment in curbing emergent DTG resistance.
“I think we are going into a remarkably complex part of our ARV rollout,” Dr. Venter concluded. “It’s interesting times. We’ve got time but we shouldn’t stick around too long because we are probably going to see a steady increase in integrase resistance in the region.”
Continuing to promote education and awareness, along with ongoing public health surveillance studies, is critical to maintain the effectiveness of ARV therapies.
To learn more about efforts to identify, understand, and respond to emerging DTG resistance, watch the webinar titled Update on Emerging HIV Drug Resistance to Integrase Inhibitors – How Concerned Should We Be?
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