Abstract Body


Kenya began rolling out DTG-based ART in late 2017 as both 1st- and 2nd-line treatment for adults and children living with HIV (PLHV). HIV drug resistance (HIVDR) data is limited in PLHIV failing DTG-based ART. We used the cyclical-acquired HIVDR (CADRE) methodology to assess the frequency of HIVDR mutations in PLHIV with detectable viremia on DTG-based ART between January and March 2023 in Kenya.


The National AIDS and STI control program(NASCOP) collected remnant plasma from HIV viral load testing between January and March 2023 from PLHIV in 15 high/moderate HIV prevalence counties receiving DTG-based ART through the Kenya HIV Care and Treatment Program. We received 191 samples from PLHIV out of the expected CADRE-calculated sample size of 622. Plasma was genotyped using Thermo-Fisher Sanger pro/RT/int sequencing on samples >200 cp/mL and mutations were identified using Stanford HIVdb v9.5. Clinical and demographic data on treatment history and duration was obtained from viral load request forms.


Samples were available for 138 of 332 (42%) adults, median age 36 [IQR 26-45] years, and 52 of 290 (18%) children (median age 15 [IQR 12-16] years) with 1 of unknown age. 146 of 191 total (76%) received DTG as 2nd-line, with 141 on NNRTI-based ART and 5 on PI-based ART for a median of 5 [IQR 2-8] years before switching to DTG-based ART; the remaining PLHIV (45 of 191; 24%) received DTG as 1st-line. 56 of 191 (29%) had HIV-1 VL >200 cp/mL; 44 of 56 (79%) were successfully genotyped. 7 of 32 (22%) ART-experienced PLHIV had INSTI resistance with E138K alone or with up to three additional major INSTI mutations including T66I, G118R, G140A, S147G, Q148KNR, and/or N155H. All 7 also had multiple NNRTI and NRTI DRMs including 5 with thymidine analogue mutations. 1 of 12 (8%) PLHIV on 1st-line TLD had VL 296 c/mL after 17 months on ART and the INSTI DRM R263K with only K70Q and M184V in RT (Table).


The frequency of INSTI HIVDR was high (22%) in ART-experienced PLHIV on DTG-based ART used as 2nd-line ART and lower (8%) in ART-naïve adults using DTG for 1st-line ART, suggesting the risk of failing DTG may be higher in a background of pre-existing mutations to NRTIs in the regimen. Our data emphasizes the importance of HIVDR monitoring in PLHIV on DTG-based ART given the anticipated introduction of long-acting cabotegravir for HIV prevention and the potential for transmission of INSTI-resistant virus from those on failing DTG-based ART to cabotegravir PrEP recipients.