Previous Article in Journal
Profile, Infection, and Vaccination Uptake: A Cohort of Canadian Retail Workers During the SARS-CoV-2 Pandemic
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Infectious Disease Reports
Volume 17
Issue 5
10.3390/idr17050123
idr-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Dolutegravir Resistance in Mozambique: Insights from a Programmatic HIV Resistance Testing Intervention in a Highly Antiretroviral Therapy-Experienced Cohort

by
Maria Ruano
1,
Antonio Flores
2,
Aleny Couto
3,
Irénio Gaspar
3,
Sabine Yerly
4,
Ana Gabriela Gutierrez Zamudio
5,
Rosa Bene
1,
Adelina Maiela
1,
Helder Macuacua
1,
Jeff Lane
6,
Florindo Mudender
1,6 and
Edy Nacarapa
1,6,*
1
I-TECH Mozambique “International Training & Education Center for Health”, Bairro Sommerschield, Avenue Cahora Bassa N# 106, Maputo P.O. Box 1102, Mozambique
2
Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town P.O. Box 7925, South Africa
3
National STI/HIV/AIDS Program, Ministry of Health, Maputo P.O. Box 264, Mozambique
4
Virology Laboratory, Hôpitaux Universitaires de Genève, P.O. Box 1205 Geneva, Switzerland
5
Médecins Sans Frontières, Maputo P.O. Box 1224, Mozambique
6
Department of Global Health, University of Washington, 908 Jefferson St., 12th Floor, Seattle, WA 98195, USA
*
Author to whom correspondence should be addressed.
Infect. Dis. Rep. 2025, 17(5), 123; https://doi.org/10.3390/idr17050123
Submission received: 25 June 2025 / Revised: 5 September 2025 / Accepted: 19 September 2025 / Published: 30 September 2025
Review Reports Versions Notes

Abstract

Background: Treatment failure continues to play a role in HIV-related morbidity in Mozambique. Antiretroviral therapy (ART) regimen switches are decided empirically, as HIV genotypic resistance testing (HIV-GT) is unavailable in Mozambique’s public health system. Since 2016, Médecins Sans Frontières (MSF) and I-TECH have provided access to HIV-GT at Alto Maé Health Center, Maputo. We describe the cohort of people with virologic failure (VF) that underwent HIV-GT and analyze dolutegravir (DTG) resistance (R) patterns. Methods: This cross-sectional assessment of routine programmatic data between July 2020 and February 2024 was conducted to guide future program enhancements. People living with HIV (PLWH) receiving ART beyond the first line with confirmed VF were included. Mutations were interpreted according to the Stanford HIVdb algorithm. We applied Bayesian bootstrapping for analysis, and the threshold for significance of effects was defined as a probability of 95%. Results: A total of 106 persons underwent HIV-GT following a structured adherence strategy, 62 (58.5%) of whom were on a DTG-based regimen. Fifty-seven of the 62 samples from persons on a DTG-based regimen were sequenced, and 51 (89.5% [95% CrI: 80.7, 96.2]) had confirmed resistance to DTG; the mean DTG-R score was 70.2 (95% CrI: 62.2, 78). Samples with DTG-R had a median of three INSTI mutations (IQR 1–4). Major DTG-associated mutations were found in 46 out of 57 samples: G118R (n = 28), R263K (n = 15), and Q148RK (n = 7). None of the people on the protease inhibitor regimen had an INSTI mutation. Conclusions: In contexts with limited access to resistance testing, the introduction of algorithms to identify PLWH at risk of developing drug resistance is strongly recommended. The proposed algorithm incorporates adherence reinforcement strategies, as recommended in national policies, followed by a short, supervised antiretroviral therapy (ART) support strategy. This approach has shown a high predictive value for identifying PLWH with resistance mutations to dolutegravir (DTG), thereby allowing the continuation of the effective DTG regimen without unnecessary regimen switches.
Keywords: HIV genotypic resistance testing; dolutegravir; HIV resistance; PLWH; Mozambique HIV genotypic resistance testing; dolutegravir; HIV resistance; PLWH; Mozambique

Share and Cite

MDPI and ACS Style

Ruano, M.; Flores, A.; Couto, A.; Gaspar, I.; Yerly, S.; Zamudio, A.G.G.; Bene, R.; Maiela, A.; Macuacua, H.; Lane, J.; et al. Dolutegravir Resistance in Mozambique: Insights from a Programmatic HIV Resistance Testing Intervention in a Highly Antiretroviral Therapy-Experienced Cohort. Infect. Dis. Rep. 2025, 17, 123. https://doi.org/10.3390/idr17050123

AMA Style

Ruano M, Flores A, Couto A, Gaspar I, Yerly S, Zamudio AGG, Bene R, Maiela A, Macuacua H, Lane J, et al. Dolutegravir Resistance in Mozambique: Insights from a Programmatic HIV Resistance Testing Intervention in a Highly Antiretroviral Therapy-Experienced Cohort. Infectious Disease Reports. 2025; 17(5):123. https://doi.org/10.3390/idr17050123

Chicago/Turabian Style

Ruano, Maria, Antonio Flores, Aleny Couto, Irénio Gaspar, Sabine Yerly, Ana Gabriela Gutierrez Zamudio, Rosa Bene, Adelina Maiela, Helder Macuacua, Jeff Lane, and et al. 2025. "Dolutegravir Resistance in Mozambique: Insights from a Programmatic HIV Resistance Testing Intervention in a Highly Antiretroviral Therapy-Experienced Cohort" Infectious Disease Reports 17, no. 5: 123. https://doi.org/10.3390/idr17050123

APA Style

Ruano, M., Flores, A., Couto, A., Gaspar, I., Yerly, S., Zamudio, A. G. G., Bene, R., Maiela, A., Macuacua, H., Lane, J., Mudender, F., & Nacarapa, E. (2025). Dolutegravir Resistance in Mozambique: Insights from a Programmatic HIV Resistance Testing Intervention in a Highly Antiretroviral Therapy-Experienced Cohort. Infectious Disease Reports, 17(5), 123. https://doi.org/10.3390/idr17050123

Article Metrics

Back to TopTop