WHO reports increasing rates of HIV drug resistance to dolutegravir

Earlier this week, the World Health Organization (WHO) issued a news release stating that there are increased trends in human immunodeficiency virus (HIV) drug resistance to dolutegravir. Despite this alarming news, the report does note relatively high rates of viral suppression among patients using this therapy.

According to the surveys, resistance to dolutegravir ranged from 3.9% to 8.6% on average; however, in some locations, resistance rates were as high as 19.6%. These rates are especially concerning because dolutegravir has been the WHO’s recommended first- and second-line therapy for individuals with HIV across all patient populations since 2018. The organization previously noted that it is a more effective and easier-to-manage drug with fewer side effects than other alternatives.

With new data on the drug’s increased resistance rates, WHO officials are emphasizing the need for increased research on HIV therapies and care delivery.

“The worrying evidence of resistance in individuals with unsuppressed viral load despite dolutegravir treatment underscores the necessity for increased vigilance and intensified efforts to optimize the quality of HIV care delivery,” said Meg Doherty, MD, PhD, Director, WHO Department of the Global HIV, Hepatitis, and STI Programs in the WHO announcement. “Standardized surveillance of HIV drug resistance is essential for effectively preventing, monitoring, and responding to these challenges.”

Beyond the challenges associated with dolutegravir resistance, the report also noted that the global goals for HIV are off track.

While 75% of the 39 million people with HIV worldwide were receiving treatment in 2022, the WHO reports 1.3 million new HIV cases and 630,000 HIV-related deaths between 2017 and 2022.

Some countries have made efforts to minimize the impact of HIV by adopting WHO guidelines for preferred treatments and increasing viral load monitoring for adults and adolescents. However, the WHO emphasizes that more countries need to implement standardized HIV drug resistance surveillance to inform guidelines and treatment programs.

“The new HIVDR report emphasizes the importance of strengthening data reporting systems so that countries can effectively monitor and report quality-of-care indicators. It underscores the active engagement by ART clinics and programs in use of indicator data to develop locally appropriate and sustainable solutions. These efforts are crucial for optimizing service delivery quality, thereby reducing the emergence of drug-resistant HIV,” concluded the news release.