{"doi":"10.1093/cid/ciae261","title":"Virologic Failure and Drug Resistance After Programmatic Switching to Dolutegravir-based First-line Antiretroviral Therapy in Malawi and Zambia","abstract":"BACKGROUND: People with human immunodeficiency virus (PWH) on first-line, nonnucleoside reverse-transcriptase inhibitor-based antiretroviral therapy (ART) were routinely switched to tenofovir-lamivudine-dolutegravir. We examined virologic outcomes and drug resistance in ART programs in Malawi, where switching was irrespective of viral load, and Zambia, where switching depended on a viral load <1000 copies/mL in the past year. METHODS: We compared the risk of viremia (≥400 copies/mL) at 1 and 2 years by viral load at switch and between countries using exact methods and logistic regression adjusted for age and sex. We performed HIV-1 pol Sanger sequencing on plasma samples with viral load ≥1000 copies/mL. RESULTS: A total of 2832 PWH were eligible (Malawi 1422, Zambia 1410); the median age was 37 years, and 2578 (91.0%) were women. At switch, 77 (5.4%) were viremic in Malawi and 42 (3.0%) in Zambia (P = .001). Viremia at switch was associated with viremia at 1 year (adjusted odds ratio (OR), 6.15; 95% confidence interval [CI], 3.13-11.4) and 2 years (7.0; 95% CI, 3.73-12.6). Viremia was less likely in Zambia than in Malawi at 1 year (OR, 0.55; 0.32-0.94) and 2 years (OR, 0.33; 0.18-0.57). Integrase sequencing was successful for 79 of 113 eligible samples. Drug resistance mutations were found in 5 PWH (Malawi 4, Zambia 1); 2 had major mutations (G118R, E138K, T66A and G118R, E138K) leading to high-level dolutegravir resistance. CONCLUSIONS: Restricting switching to dolutegravir-based ART to PWH with a viral load <1000 copies/mL may reduce subsequent viremia and, consequently, the emergence of dolutegravir drug resistance mutations. CLINICAL TRIALS REGISTRATION: Clinicaltrials.gov (NCT04612452).","journal":"Clinical Infectious Diseases","year":2024,"id":430733,"datarank":0.8371111319948581,"base_score":2.9444389791664403,"endowment":2.9444389791664403,"self_citation_contribution":0.44166584687496613,"citation_network_contribution":0.395445285119892,"self_endowment_contribution":0.44166584687496613,"citer_contribution":0.395445285119892,"corpus_percentile":null,"corpus_rank":null,"citation_count":18,"citer_count":16,"citers_with_citation_signal":7,"citers_with_endowment":7,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9597,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT04612452"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1058568,"name":"Jacqueline Huwa","orcid":"0000-0001-8786-2487","position":1,"is_corresponding":false},{"id":764937,"name":"Guy Muula","orcid":null,"position":2,"is_corresponding":false},{"id":1059105,"name":"Geldert Chiwaya","orcid":null,"position":3,"is_corresponding":false},{"id":1234551,"name":"E. de la Banda","orcid":null,"position":4,"is_corresponding":false},{"id":1234552,"name":"Shameem Buleya","orcid":null,"position":5,"is_corresponding":false},{"id":454872,"name":"Belinda Chihota","orcid":"0000-0001-6565-9306","position":6,"is_corresponding":false},{"id":1059104,"name":"Joseph Chintedza","orcid":null,"position":7,"is_corresponding":false},{"id":371004,"name":"Carolyn Bolton‐Moore","orcid":"0000-0001-9103-7746","position":8,"is_corresponding":false},{"id":597212,"name":"Hannock Tweya","orcid":"0000-0002-8247-1273","position":9,"is_corresponding":false},{"id":704661,"name":"Thokozani Kalua","orcid":"0000-0001-7384-9011","position":10,"is_corresponding":false},{"id":1018177,"name":"Stefanie Hossmann","orcid":"0000-0003-1600-5925","position":11,"is_corresponding":false},{"id":69664,"name":"Roger D. Kouyos","orcid":"0000-0002-9220-8348","position":12,"is_corresponding":false},{"id":364593,"name":"Gilles Wandeler","orcid":"0000-0002-5278-8763","position":13,"is_corresponding":false},{"id":4469,"name":"Matthias Egger","orcid":"0000-0001-7462-5132","position":14,"is_corresponding":false},{"id":69666,"name":"Richard Lessells","orcid":"0000-0003-0926-710X","position":15,"is_corresponding":false},{"id":614368,"name":"Veronika Skrivankova","orcid":"0000-0003-0932-4792","position":0,"is_corresponding":true}],"reference_count":30,"raw_metadata":null,"created_at":"2026-07-19T01:59:20.861374Z","pmid":"38847281","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}