ArticleThe lancet. HIV2023
HIV-1 drug resistance in people on dolutegravir-based antiretroviral therapy: a collaborative cohort analysis.
Article in The lancet. HIV, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 88 papers.
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Who cites it
88 citing papers in PubMed, 121 citations in OpenAlex.
- HIV drug resistance amongst children and adolescents with viraemia in Lesotho and Tanzania: a nested analysis in the GIVE MOVE trial.The Journal of antimicrobial chemotherapy · 2026Trial
- A Randomized Trial to Compare Dolutegravir Plus Boosted Darunavir Versus Recommended Standard of Care Antiretroviral Regimens in People With HIV-1, Whose First-line Non-nucleoside Reverse Transcriptase Inhibitor Therapy Has Failed: Final 96-week Results of the D2EFT Study.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Trial
- Trial
- Phase 1 Evaluation of VH4524184, a Third-Generation Integrase Strand Transfer Inhibitor With an Enhanced Resistance Profile.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Trial
- Trial
- Virtual screening and cellular validation of dolutegravir as a BRD9 inhibitor for attenuating pyroptosis in peritoneal mesothelial cells.Renal failure · 2026Article
- Article
- Long-Acting Injectable Cabotegravir/Rilpivirine as a Second-Line ART Regimen for Pregnant and Breastfeeding Women in Kenya: Modeling the Potential Impact on Vertical Transmission.Open forum infectious diseases · 2026Article
- Pretreatment Resistance to Integrase Inhibitors in the Swiss HIV Cohort Study From 1995 to 2025.Open forum infectious diseases · 2026Article
- Patterns of HIV-1 Viral Load Suppression and Drug Resistance During the Dolutegravir Transition: A Population-based Longitudinal Study.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Article
- Baseline Data on Viral Suppression, Treatment Adherence and Mental Health in Peripartum Girls and Young Women With HIV in Zimbabwe.Journal of the International AIDS Society · 2026Observational
- Antiretroviral resistance in at least second-line HIV-1 treatment virologic failure with common InSTI-based regimens.AIDS (London, England) · 2026Observational
- Timeliness of switching to second-line antiretroviral therapy following virologic failure in Dar es Salaam, Tanzania.BMC research notes · 2026Article
- Emerging Dolutegravir Resistance Among Children on Antiretroviral Therapy With Virological Failure in Malawi: Results From a 2023 National Cross-Sectional Survey.Journal of the International AIDS Society · 2026Article
- HIV-1 Sub-subtype A6 Remains Susceptible to Second-Generation Integrase Inhibitors With Limited Emergence of Resistance in Vitro.Open forum infectious diseases · 2026Article
- HIV Resistance to Dolutegravir Varies With Coadministered Agents.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Article
- Novel integrase mutations linked to genotypic DTG resistance in African non-B HIV-1 strains: the DTG RESIST study.The Journal of antimicrobial chemotherapy · 2026Article
- Virologic, immunologic, and metabolic outcomes and mortality in people with HIV on bictegravir/emtricitabine/tenofovir alafenamide fumarate versus dolutegravir-based antiretroviral therapies: a retrospective multicenter cohort study in China.The Lancet regional health. Western Pacific · 2026Article
- The Epidemiology of HIV-1 Resistance to Two-Drug Regimens in Multicenter Cohort From Poland-A Cross-Sectional Study.Health science reports · 2026Article
- National representative survey of pretreatment HIV drug resistance in Colombia: analysis of antiretroviral resistance-associated mutations using next-generation sequencing.The Journal of antimicrobial chemotherapy · 2026Article
28 more citing papers are in PubMed but not listed here.
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Authors and funding
18 authors at 10 institutions in 7 countries.
Funding
Abstract
backgroundThe widespread use of the integrase strand transfer inhibitor (INSTI) dolutegravir in first-line and second-line antiretroviral therapy (ART) might facilitate emerging resistance. The DTG RESIST study combined data from HIV cohorts to examine patterns of drug resistance mutations (DRMs) and identify risk factors for dolutegravir resistance.
methodsWe included cohorts with INSTI resistance data from two collaborations (ART Cohort Collaboration, International epidemiology Databases to Evaluate AIDS in Southern Africa), and the UK Collaborative HIV Cohort. Eight cohorts from Canada, France, Germany, Italy, the Netherlands, Switzerland, South Africa, and the UK contributed data on individuals who were viraemic on dolutegravir-based ART and underwent genotypic resistance testing. Individuals with unknown dolutegravir initiation date were excluded. Resistance levels were categorised using the Stanford algorithm. We identified risk factors for resistance using mixed-effects ordinal logistic regression models.
findingsWe included 599 people with genotypic resistance testing on dolutegravir-based ART between May 22, 2013, and Dec 20, 2021. Most had HIV-1 subtype B (n=351, 59%), a third had been exposed to first-generation INSTIs (n=193, 32%), 70 (12%) were on dolutegravir dual therapy, and 18 (3%) were on dolutegravir monotherapy. INSTI DRMs were detected in 86 (14%) individuals; 20 (3%) had more than one mutation. Most (n=563, 94%) were susceptible to dolutegravir, seven (1%) had potential low, six (1%) low, 17 (3%) intermediate, and six (1%) high-level dolutegravir resistance. The risk of dolutegravir resistance was higher on dolutegravir monotherapy (adjusted odds ratio [aOR] 34·1, 95% CI 9·93-117) and dolutegravir plus lamivudine dual therapy (aOR 9·21, 2·20-38·6) compared with combination ART, and in the presence of potential low or low (aOR 5·23, 1·32-20·7) or intermediate or high-level (aOR 13·4, 4·55-39·7) nucleoside reverse transcriptase inhibitor (NRTI) resistance.
interpretationAmong people with viraemia on dolutegravir-based ART, INSTI DRMs and dolutegravir resistance were rare. NRTI resistance substantially increased the risk of dolutegravir resistance, which is of concern, notably in resource-limited settings. Monitoring is important to prevent resistance at the individual and population level and ensure the long-term sustainability of ART.
fundingUS National Institutes of Health, Swiss National Science Foundation.
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