Patterns of HIV-1 viral load suppression and drug resistance during the dolutegravir transition: a population-based longitudinal study
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
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 living with HIV (PLHIV), 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 PLHIV, 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 PLHIV underscores the role of ART adherence in reducing viremia. The emergence of inS153Y justifies continued surveillance.
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 living with HIV (PLHIV), 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 PLHIV, 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 PLHIV underscores the role of ART adherence in reducing viremia. The emergence of inS153Y justifies continued surveillance.
Date Issued
2026-06-15
Date Acceptance
2026-02-19
Citation
Clinical Infectious Diseases, 2026, 82 (6), pp.e1242-e1251
ISSN
1058-4838
Publisher
Oxford University Press (OUP)
Start Page
e1242
End Page
e1251
Journal / Book Title
Clinical Infectious Diseases
Volume
82
Issue
6
Copyright Statement
© 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, distri bution, and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/41819144
PII: 8516728
Subjects
HIV
Uganda
Viral suppression
drug resistance
population-based
Publication Status
Published
Coverage Spatial
United States
Article Number
ciag161
Date Publish Online
2026-03-13