Approaches to the Management of Virologic Failure on Dolutegravir-Based Antiretroviral Therapy in the 50 Countries With the Highest Adult HIV Prevalence
Year: 2025
Type: article
Abstract: Expanded access to dolutegravir as part of a fixed-dose combination with tenofovir disoproxil fumarate and lamivudine (TLD) has revolutionized global human immunodeficiency virus (HIV) treatment, with more than 25 million people prescribed this regimen in 2024. We reviewed national clinical guidelines for management of virologic failure on first-line TLD in the 50 countries with the highest prevalence of HIV among adults; recent guidelines were not available online for four. Among the remaining 46 country guidelines, we identified four distinct approaches: (1) empiric switch to a protease inhibitor (PI)-based regimen without genotypic resistance testing (GRT) (n = 28; 61%); (2) GRT to guide antiretroviral therapy selection (n = 14; 30%); (3) continuation of TLD without GRT (n = 3; 7%); and (4) empiric switch to a PI-based regimen with concurrent GRT (n = 1; 2%). The diversity of guideline-endorsed approaches underscores the critical need for additional data to inform policy regarding this important clinical scenario.
Source: Clinical Infectious Diseases
DOI: 10.1093/cid/ciaf444
Institutions: Brigham and Women's Hospital, Harvard University, Massachusetts General Hospital, Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Mbarara University of Science and Technology, University of Zurich, University Hospital Zurich, University of Nairobi, R. K. Khan Hospital, University of California, San Francisco, World Health Organization, Tufts University, Tufts Medical Center, Universidade Nova de Lisboa, Africa Health Research Institute
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: NHS Innovation Accelerator, Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung, National Institute of Development Administration, Fundación Interhospitalaria para la Investigación Cardiovascular, National Institutes of Health, National Cancer Institute, Cairo University, National Heart, Lung, and Blood Institute, National Institute of Mental Health, National Institute of Nursing Research, National Institute of Allergy and Infectious Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Dental and Craniofacial Research, National Institute on Minority Health and Health Disparities, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NOAA Research
OpenAlex ID: W4413112889