TY - JOUR
T1 - Patterns of HIV-1 Viral Load Suppression and Drug Resistance During the Dolutegravir Transition
T2 - A Population-based Longitudinal Study
AU - Martin, Michael A.
AU - Blenkinsop, Alexandra
AU - Moffa, Michelle
AU - Reynolds, Steven James
AU - Nalugoda, Fred
AU - Quinn, Thomas C.
AU - Kigozi, Godfrey
AU - Ssekubugu, Robert
AU - Gupta, Ravindra K.
AU - Grayson, Nicholas E.
AU - MacIntyre-Cockett, George
AU - Kagaayi, Joseph
AU - Nakigozi, Gertrude
AU - Abeler-Dörner, Lucie
AU - Fraser, Christophe
AU - Ratmann, Oliver
AU - Tobian, Aaron A.R.
AU - Laeyendecker, Oliver
AU - Moyo, Sikhulile
AU - Kennedy, Caitlin E.
AU - Bonsall, David
AU - Galiwango, Ronald Moses
AU - Grabowski, M. Kate
N1 - Publisher Copyright:
© The Author(s) 2026. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
PY - 2026/6/15
Y1 - 2026/6/15
N2 - Background: Data on the population-scale impact of dolutegravir (DTG)-based HIV regimens in sub-Saharan Africa are extremely limited. We used data from a surveillance cohort in southern Uganda to assess viral suppression and antiretroviral (ART) resistance over 10-years alongside DTG scale-up. Methods: Consenting participants in the population-based Rakai Community Cohort Study between August 2011 and March 2023 aged 15–49 completed questionnaires and provided samples for HIV testing, viral load quantification, and viral deep-sequencing. We collected data on DTG utilization at HIV care clinics. We estimated the prevalence of HIV suppression and ART resistance using robust Poisson regression. Bayesian logistic regression quantified associations between resistance and individual-level suppression across surveys. Results: Among 8781 people with HIV (PWH), suppression increased from 57.1% (2014, 95% confidence interval [CI], 55.4%–58.8%) to 90.3% (2022, 95% CI, 89.2%–91.4%). By 2020 84.4% (95% CI, 83.7%–85.2%) and 64.6% (95% CI, 63.9%–65.3%) of men and women on ART were on DTG. Among treatment-experienced viremic PWH, any intermediate/high resistance decreased from 51.1% (95% CI, 40.7%–64.2%, 2014) to 27.9% (95% CI, 21.3%–36.5%, 2022). Two of 258 (0.8%) 2022 participants harbored intermediate/high-level DTG resistance (inQ148R, inE138K, and inG140A). inS153Y (2-fold INSTI resistance) was observed in 23/306 (7.5%) of viremic individuals, with evidence of transmission. By 2022, NNRTI/NRTI resistance was not associated with a reduction in individual-level suppression (risk ratios: 1.15, 95% HPD: 0.93–1.39; 1.14, 0.86–1.42). Conclusions: Viral suppression increased during the DTG transition with minimal emerging intermediate/high-level resistance. Falling resistance among treatment-experienced PWH underscores the role of ART adherence in reducing viremia. The emergence of inS153Y justifies continued surveillance.
AB - Background: Data on the population-scale impact of dolutegravir (DTG)-based HIV regimens in sub-Saharan Africa are extremely limited. We used data from a surveillance cohort in southern Uganda to assess viral suppression and antiretroviral (ART) resistance over 10-years alongside DTG scale-up. Methods: Consenting participants in the population-based Rakai Community Cohort Study between August 2011 and March 2023 aged 15–49 completed questionnaires and provided samples for HIV testing, viral load quantification, and viral deep-sequencing. We collected data on DTG utilization at HIV care clinics. We estimated the prevalence of HIV suppression and ART resistance using robust Poisson regression. Bayesian logistic regression quantified associations between resistance and individual-level suppression across surveys. Results: Among 8781 people with HIV (PWH), suppression increased from 57.1% (2014, 95% confidence interval [CI], 55.4%–58.8%) to 90.3% (2022, 95% CI, 89.2%–91.4%). By 2020 84.4% (95% CI, 83.7%–85.2%) and 64.6% (95% CI, 63.9%–65.3%) of men and women on ART were on DTG. Among treatment-experienced viremic PWH, any intermediate/high resistance decreased from 51.1% (95% CI, 40.7%–64.2%, 2014) to 27.9% (95% CI, 21.3%–36.5%, 2022). Two of 258 (0.8%) 2022 participants harbored intermediate/high-level DTG resistance (inQ148R, inE138K, and inG140A). inS153Y (2-fold INSTI resistance) was observed in 23/306 (7.5%) of viremic individuals, with evidence of transmission. By 2022, NNRTI/NRTI resistance was not associated with a reduction in individual-level suppression (risk ratios: 1.15, 95% HPD: 0.93–1.39; 1.14, 0.86–1.42). Conclusions: Viral suppression increased during the DTG transition with minimal emerging intermediate/high-level resistance. Falling resistance among treatment-experienced PWH underscores the role of ART adherence in reducing viremia. The emergence of inS153Y justifies continued surveillance.
KW - HIV
KW - Uganda
KW - drug resistance
KW - population-based
KW - viral suppression
UR - https://www.scopus.com/pages/publications/105043878996
UR - https://www.scopus.com/pages/publications/105043878996#tab=citedBy
U2 - 10.1093/cid/ciag161
DO - 10.1093/cid/ciag161
M3 - Article
C2 - 41819144
AN - SCOPUS:105043878996
SN - 1058-4838
VL - 82
SP - e1242-e1251
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 6
ER -