Dolutegravir (DTG) - associated antiretroviral drug resistance: two case reports
DOI:
https://doi.org/10.14456/taj.2025.14Keywords:
HIV drug resistance, factors influencing antiretroviral resistance, dolutegravir (DTG)Abstract
Dolutegravir (DTG) has been recommended as the first-line antiretroviral treatment in Thailand since 2021; but data on DTG resistance remains limited. This article presents 2 cases of DTG resistance and emphasizes the importance of reviewing antiretroviral resistance history to guide optimal regimen selection. This study presents the first hospital-reported cases of DTG resistance, with possible contributing factors including prior treatment interruptions, documented resistance mutations to efavirenz (EFV) and nevirapine (NVP), a history of receiving previously ineffective regimens, and drug–drug or drug–food interactions affecting antiretroviral efficacy. Despite the emergence of DTG resistance, both patients remained on DTG-based therapy. For the first patient, viral load (VL) declined from 289,152 to <40 copies/mL and CD4 count increased from 252 to 435 cells/mm³. In the second patient, VL decreased from 7,924 to 299 copies/mL and CD4 count increased from 80 to 210 cells/mm³. These outcomes suggest favorable treatment responses despite the presence of resistance, particularly when DTG is combined with agents that have a high resistance barrier and potent antiviral activity such as darunavir (DRV) boosted with ritonavir (RTV). This study highlights the importance of reviewing resistance history to optimize HIV treatment regimens and prevent further drug resistance. However, limitations remain due to the small number of cases and the lack of long-term VL and CD4 follow-up.
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