Table 1.
Clinical Details of Patients With DTG Resistance Mutations
| Client Number | Agea | Sex | Total Duration ART, mo | Current Regimen (Duration, mo) | On First- or Second-Line Regimenb | Previous ART Regimensc | Virological Status at Switch to DTG Regimen | Pill Count Adherenced | Self-Reported Adherencee | Adherence Assessment After IAC Sessionsf | Viremia Duration on DTG Regimen, mog | Clinical Status | Potential DTG Drug Interactions |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 46 | M | 29 | TDF/3TC/DTG (29) | 1st | None | NA | Optimal | Optimal | Good | 4 | CD4 = 61; HBsAg positive, weight loss | Unknown herbal medications |
| 2 | 39 | M | 123 | TDF/3TC/DTG (23) | 1st | d4T/3TC/NVP, TDF/3TC/EFV | No VL available | Suboptimal | Optimal | Good | 13 | No CD4 count available; asymptomatic | None |
| 3 | 38 | M | 121 | TDF/3TC/DTG (23) | 1st | d4T/3TC/NVP, TDF/3TC/EFV | No VL available | Optimal | Good | Good | 13 | No CD4 count available; asymptomatic | None |
| 4 | 20 | M | 125 | TDF/3TC/DTG (28) | 1st | d4T/3TC/NVP, AZT/3TC/NVP | No VL available | Suboptimal | Optimal | No info | 28 | No CD4 count available; asymptomatic | None |
| 5 | 41 | M | 30 | TDF/3TC/DTG (24) | 1st | TDF/3TC/EFV | No VL available | Optimal | Optimal | Good | 20 | No CD4 count available; asymptomatic | None |
| 6 | 42 | M | 179 | TDF/3TC/DTG (7) | 2nd | d4T/3TC/NVP, TDF/3TC/EFV, AZT/3TC + ATV/r | No VL available | Suboptimal | Optimal | Good | 3 | CD4 = 70; weight loss; active EPTB | Rifampicin; DTG dose was doubled during TB treatment |
| 7 | 15 | F | 26 | TDF/3TC/DTG (9) | 2nd | ABC/3TC + LPV/r | >300 000 copies/mL | Suboptimal | Suboptimal | No info | 12 | No CD4 count available; asymptomatic | None |
| 8 | 46 | M | 126 | TDF/3TC/DTG (8) | 2nd | d4T/3TC/NVP, TDF/3TC/EFV AZT/3TC + ATV/r | >22 000 copies/mL | Suboptimal | Suboptimal | Suboptimal | 8 | CD4 = 180; asymptomatic | None |
Abbreviations: 3TC, lamivudine; ABC, abacavir; ART, antiretroviral therapy; ATV, atazanavir; AZT, zidovudine; DTG, dolutegravir; EFV, efavirenz; IAC, intensive adherence counseling; LPV, lopinavir; NA, not applicable (the Malawi national HIV guidelines do not support VL testing at ART initiation); NVP, nevirapine; r, ritonavir; TDF, tenofovir; VL, viral load.
Age is at the time of application for genotyping.
Second line: switched from PI-based second-line regimen to TDF/3TC/DTG, as recommended in national guidelines.
Including single-drug changes due to side effects and listed from oldest to most recent.
Optimal = 95%–105% pill count adherence; suboptimal = any value outside the optimal range.
Optimal = positive response to all 3 questions; suboptimal = negative response to any of 3 questions.
Narrative description by submitting clinician.
From the time of the first VL >1000 copies/mL result on the DTG-based regimen to the application date for HIVDR testing.