HIV: WHO reports “worrying” increase in resistance to key antiretroviral treatment

Resistance to the first line HIV antiretroviral drug dolutegravir is growing and exceeding levels seen in clinical trials, the World Health Organization has warned.1

Surveys conducted in Malawi, Uganda, and Ukraine found that levels of resistance among those receiving dolutegravir based antiretroviral treatment with viral non-suppression ranged from 3.9% to 8.6%. Previous clinical trial data suggested a resistance level of below 3%.

In Mozambique, a survey also found that among treatment experienced people who had begun taking dolutegravir while having high HIV viral loads, resistance reached 19.6%.

WHO has called on countries to put monitoring systems in place to track and respond to resistance. It said access to treatment adherence interventions must also be expanded.

Since 2018, WHO has recommended dolutegravir as the preferred first and second line HIV treatment for all population groups. In 2022, there were 39 million people living with HIV globally.

The report found that while nearly three quarters (74%) of low and middle income countries have implemented viral load monitoring for adults and adolescents, just 12 of the 45 countries with the highest HIV burden have conducted resistance surveys or integrated early warning indicators for resistance into routine monitoring systems.

Meg Doherty, director of the WHO Department of Global HIV, Hepatitis, and Sexually Transmitted Infections Programmes, said, “The worrying evidence of resistance in people with unsuppressed viral load despite dolutegravir treatment underscores the necessity for increased vigilance and intensified efforts to optimise the quality of HIV care delivery.”