Virologic failure on dolutegravir‑based second‑line ART: Real‑world outcomes from Harare, Zimbabwe
1
Newlands Clinic, Harare, Zimbabwe
2
Graduate School for Health Sciences, University of Bern Institute of Social and Preventive Medicine, Bern, Switzerland
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Dolutegravir (DTG) is widely used in antiretroviral therapy (ART) due to its high genetic barrier to resistance; however, real-world data on DTG failure remain limited in Africa. We evaluated virologic and clinical outcomes among people living with HIV (PLWH) who experienced virologic failure (VF) on DTG-based second-line ART at Newlands Clinic, Harare, Zimbabwe.
METHODS:
We conducted a retrospective cohort study of PLWH who switched from protease inhibitor (PI)–based ART (atazanavir/r or lopinavir/r) to DTG-based ART between January 2019 and June 2025. Participants were eligible if they remained on ART for ≥6 months ,had at least one follow-up viral load (VL) after VF on DTG. VF was defined as two consecutive VLs ≥1000 copies/mL ≥3 months apart and viral suppression as <1000 copies/mL. Demographic characteristics, ART history, VL results, resistance testing, and attrition outcomes were extracted from electronic medical records. Outcomes were described among participants who continued DTG following adherence support and those switched to darunavir (DRV)–containing third-line therapy.
RESULTS:
We assessed 161 participants (80 [49.7%] female; median age 24.5 years [IQR 21–29]) who experienced VF on DTG-based second-line ART. At DTG switch, 87 (54%) had suppressed VL. Median time on DTG was 25.8 months (IQR 16.2–39.6). Genotyping was successful in 32 (19.9%) participants; 13 (40.6%) had major DTG resistance-associated mutations, of whom 8 were unsuppressed at DTG initiation. At analysis, 131 remained in care, 8 were lost to follow-up, 13 transferred out, and 9 died. Twenty-seven participants were switched to third-line therapy (DRV/r + DTG + NRTI), of whom 81% (22/27) achieved viral suppression. Among those who remained on DTG, 68.3% (71/104) re-suppressed.
CONCLUSIONS:
Most participants achieved viral re-suppression on DTG following adherence support without requiring third-line therapy. Emergent DTG resistance was uncommon among those with available genotypes, underscoring the critical role of adherence counselling in managing virologic failure.
Dolutegravir (DTG) is widely used in antiretroviral therapy (ART) due to its high genetic barrier to resistance; however, real-world data on DTG failure remain limited in Africa. We evaluated virologic and clinical outcomes among people living with HIV (PLWH) who experienced virologic failure (VF) on DTG-based second-line ART at Newlands Clinic, Harare, Zimbabwe.
METHODS:
We conducted a retrospective cohort study of PLWH who switched from protease inhibitor (PI)–based ART (atazanavir/r or lopinavir/r) to DTG-based ART between January 2019 and June 2025. Participants were eligible if they remained on ART for ≥6 months ,had at least one follow-up viral load (VL) after VF on DTG. VF was defined as two consecutive VLs ≥1000 copies/mL ≥3 months apart and viral suppression as <1000 copies/mL. Demographic characteristics, ART history, VL results, resistance testing, and attrition outcomes were extracted from electronic medical records. Outcomes were described among participants who continued DTG following adherence support and those switched to darunavir (DRV)–containing third-line therapy.
RESULTS:
We assessed 161 participants (80 [49.7%] female; median age 24.5 years [IQR 21–29]) who experienced VF on DTG-based second-line ART. At DTG switch, 87 (54%) had suppressed VL. Median time on DTG was 25.8 months (IQR 16.2–39.6). Genotyping was successful in 32 (19.9%) participants; 13 (40.6%) had major DTG resistance-associated mutations, of whom 8 were unsuppressed at DTG initiation. At analysis, 131 remained in care, 8 were lost to follow-up, 13 transferred out, and 9 died. Twenty-seven participants were switched to third-line therapy (DRV/r + DTG + NRTI), of whom 81% (22/27) achieved viral suppression. Among those who remained on DTG, 68.3% (71/104) re-suppressed.
CONCLUSIONS:
Most participants achieved viral re-suppression on DTG following adherence support without requiring third-line therapy. Emergent DTG resistance was uncommon among those with available genotypes, underscoring the critical role of adherence counselling in managing virologic failure.
| eISSN: | 2654-1459 |
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