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

This study characterized HIV drug resistance among people living with HIV(PLWH) in Francistown, Botswana with detectable viral load>200copies/mL on antiretroviral therapy for at least six months. The study utilized residual viral load (VL) plasma samples from 100 PLWH collected from November 2023-January 2024. HIV pol region was genotyped using the next generation sequencing platform and known HIV drug resistance mutations were identified using the Stanford HIV drug resistance database at >20% allele frequency.

Among 100 participants, the majority (83.0%) were on dolutegravir-based antiretroviral therapy. These individuals were further classified by VL groups; 30 participants had low-level viremia (201-999 copies/mL) and 70 with VL≥1000 copies/mL.  A total of 58 individuals were successfully sequenced leading to 33% with at least one drug resistance mutation in overall.  However, among participants on dolutegravir-based ART with detectable viremia, about 35% had at least one drug resistance mutation. Individuals with low-level viremia harbour the similar prevalence of drug resistance mutations as those who are failing at VL≥1000 copies/mL. The study revealed high resistance to legay drugs among individuals with detectable viremia on current treatment which may impact the effectiveness of the current drugs.  Continual drug resistance monitoring is essential in guiding the current treatments strategies.   Despite the study’s limited sample size and lack of historic drugs data, the study revealed the   possibility of using confirmed detectable VL residual samples for HIV drug resistance testing which will shorten the turnaround time, especially in resource-limited settings where VL results turnaround time is lengthy.