High prevalence of reverse transcriptase inhibitors associated resistance mutations among people living with HIV on dolutegravir-based antiretroviral therapy in Francistown, Botswana

This research looked at how common HIV drug resistance is among people living with HIV in Francistown, Botswana who had a detectable amount of virus in their blood despite being on dolutegravir‑based treatment for at least six months. The team analysed blood samples from 100 adults collected between November 2023 and January 2024 to check for changes in the virus that make it resistant to different drug types.  

Out of these, 58 samples could be successfully analysed for resistance. About 35% of people on dolutegravir‑based therapy had at least one drug resistance mutation, whether their virus levels were low or high. Mutations linked to the older classes of drugs that act on reverse transcriptase were especially common, reflecting past use of those drugs. Resistance specifically associated with dolutegravir or similar drugs was low (around 5%), but not absent. Some individuals carried mutations that can affect how well these drugs work, and many had resistance to older treatments they had used before switching to dolutegravir. 

The study highlights that, even with modern treatment like dolutegravir, resistance to older drug types remains frequent among people with detectable virus. Regular monitoring of resistance patterns is important to make sure current treatments continue to work well and to guide decisions about future therapy. The authors also note limitations such as the small sample size and using leftover test samples, which may affect how broadly the results apply.