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Kanise H, van Oosterhout JJ, Bisani P, Songo J, Matola BW, Chipungu C, Simon K, Cox C, Hosseinipour MC, Sagno JB, Hoffman RM, Wallrauch C, Phiri S, Steegen K, Jahn A, Nyirenda R, Heller T. Virological Findings and Treatment Outcomes of Cases That Developed Dolutegravir Resistance in Malawi's National HIV Treatment Program. Viruses 2023; 16:29. [PMID: 38257730 PMCID: PMC10819735 DOI: 10.3390/v16010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/28/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
Millions of Africans are on dolutegravir-based antiretroviral therapy (ART), but few detailed descriptions of dolutegravir resistance and its clinical management exist. We reviewed HIV drug resistance (HIVDR) testing application forms submitted between June 2019 and October 2022, data from the national HIVDR database, and genotypic test results. We obtained standardized ART outcomes and virological results of cases with dolutegravir resistance, and explored associations with dolutegravir resistance among individuals with successful integrase sequencing. All cases were on two nucleoside reverse transcriptase inhibitors (NRTIs)/dolutegravir, and had confirmed virological failure, generally with prolonged viremia. Among 89 samples with successful integrase sequencing, 24 showed dolutegravir resistance. Dolutegravir resistance-associated mutations included R263K (16/24), E138K (7/24), and G118R (6/24). In multivariable logistic regression analysis, older age and the presence of high-level NRTI resistance were significantly associated with dolutegravir resistance. After treatment modification recommendations, four individuals (17%) with dolutegravir resistance died, one self-discontinued ART, one defaulted, and one transferred out. Of the 17 remaining individuals, 12 had follow-up VL results, and 11 (92%) were <1000 copies/mL. Twenty-four cases with dolutegravir resistance among 89 individuals with confirmed virological failure suggests a considerable prevalence in the Malawi HIV program. Successful management of dolutegravir resistance was possible, but early mortality was high. More research on the management of treatment-experienced individuals with dolutegravir resistance is needed.
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Affiliation(s)
- Hope Kanise
- Partners in Hope, Lilongwe P.O. Box 302, Malawi; (H.K.); (J.S.); (C.C.); (S.P.)
| | - Joep J. van Oosterhout
- Partners in Hope, Lilongwe P.O. Box 302, Malawi; (H.K.); (J.S.); (C.C.); (S.P.)
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA;
| | - Pachawo Bisani
- The Lighthouse Trust, Lilongwe P.O. Box 106, Malawi; (P.B.); (C.W.); (T.H.)
| | - John Songo
- Partners in Hope, Lilongwe P.O. Box 302, Malawi; (H.K.); (J.S.); (C.C.); (S.P.)
| | - Bilaal W. Matola
- Directorate of HIV, STI and Viral Hepatitis, Ministry of Health, Lilongwe P.O. Box 30377, Malawi; (B.W.M.); (A.J.); (R.N.)
| | - Chifundo Chipungu
- Partners in Hope, Lilongwe P.O. Box 302, Malawi; (H.K.); (J.S.); (C.C.); (S.P.)
| | - Katherine Simon
- Baylor College of Medicine Children’s Foundation-Malawi, Lilongwe P.O. Box 110, Malawi; (K.S.); (C.C.)
- Baylor College of Medicine, Houston, TX 77030, USA
| | - Carrie Cox
- Baylor College of Medicine Children’s Foundation-Malawi, Lilongwe P.O. Box 110, Malawi; (K.S.); (C.C.)
- Baylor College of Medicine, Houston, TX 77030, USA
| | - Mina C. Hosseinipour
- University of North Carolina Project Malawi, Lilongwe Private Bag A-104, Malawi;
- Department of Medicine, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC 27599, USA
| | | | - Risa M. Hoffman
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA;
| | - Claudia Wallrauch
- The Lighthouse Trust, Lilongwe P.O. Box 106, Malawi; (P.B.); (C.W.); (T.H.)
| | - Sam Phiri
- Partners in Hope, Lilongwe P.O. Box 302, Malawi; (H.K.); (J.S.); (C.C.); (S.P.)
- School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe P.O. Box 30184, Malawi
| | - Kim Steegen
- Department of Haematology & Molecular Medicine, National Health Laboratory Service, Johannesburg 2131, South Africa;
- Department of Haematology & Molecular Medicine, University of the Witwatersrand, Johannesburg 2017, South Africa
| | - Andreas Jahn
- Directorate of HIV, STI and Viral Hepatitis, Ministry of Health, Lilongwe P.O. Box 30377, Malawi; (B.W.M.); (A.J.); (R.N.)
- Department of Global Health, University of Washington, Seattle, WA 98195, USA
| | - Rose Nyirenda
- Directorate of HIV, STI and Viral Hepatitis, Ministry of Health, Lilongwe P.O. Box 30377, Malawi; (B.W.M.); (A.J.); (R.N.)
| | - Tom Heller
- The Lighthouse Trust, Lilongwe P.O. Box 106, Malawi; (P.B.); (C.W.); (T.H.)
- International Training and Education Center for Health (ITECH), University of Washington, Seattle, WA 98104-2499, USA
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van Oosterhout JJ, Chipungu C, Nkhoma L, Kanise H, Hosseinipour MC, Sagno JB, Simon K, Cox C, Hoffman R, Steegen K, Matola BW, Phiri S, Jahn A, Nyirenda R, Heller T. Dolutegravir resistance in Malawi’s national HIV treatment program. Open Forum Infect Dis 2022; 9:ofac148. [PMID: 35493118 PMCID: PMC9045949 DOI: 10.1093/ofid/ofac148] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/04/2022] [Indexed: 11/24/2022] Open
Abstract
Dolutegravir HIV drug resistance (HIVDR) data from Africa remain sparse. We reviewed HIVDR results of Malawians on dolutegravir-based antiretroviral therapy (November 2020–September 2021). Of 6462 eligible clients, 33 samples were submitted to South Africa, 27 were sequenced successfully, and 8 (30%) had dolutegravir HIVDR. Malawi urgently requires adequate HIVDR testing capacity.
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Affiliation(s)
- J J van Oosterhout
- Partners in Hope, Lilongwe, Malawi
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, USA
| | | | - L Nkhoma
- The Lighthouse Trust, Lilongwe, Malawi
| | - H Kanise
- Partners in Hope, Lilongwe, Malawi
| | | | - J B Sagno
- DREAM, Communion of St. Egidio, Malawi
| | - K Simon
- Baylor College of Medicine Children’s Foundation-Malawi, Lilongwe, Malawi
- Baylor International Pediatric AIDS Initiative, Houston, USA
| | - C Cox
- Baylor College of Medicine Children’s Foundation-Malawi, Lilongwe, Malawi
- Baylor International Pediatric AIDS Initiative, Houston, USA
| | - R Hoffman
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - K Steegen
- Department of Haematology & Molecular Medicine, National Health Laboratory Service, Johannesburg, South Africa
- Department of Haematology & Molecular Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - B W Matola
- Department of Public Health and Family Medicine, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - S Phiri
- Partners in Hope, Lilongwe, Malawi
- Department of Public Health and Family Medicine, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - A Jahn
- Department of HIV-AIDS, Ministry of Health, Lilongwe, Malawi
| | - R Nyirenda
- Department of HIV-AIDS, Ministry of Health, Lilongwe, Malawi
| | - T Heller
- The Lighthouse Trust, Lilongwe, Malawi
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