Case Report

Rapid emergence of dolutegravir resistance on second-line dolutegravir-based ART

Kirusha Naidoo, Richard J. Lessells, Jienchi Dorward, Mahomed Y.S. Moosa, Yukteshwar Sookrajh, Pravi Moodley, Paul K. Drain, Nigel Garrett
Southern African Journal of HIV Medicine | Vol 26, No 1 | a1701 | DOI: https://doi.org/10.4102/sajhivmed.v26i1.1701 | © 2025 Kirusha Naidoo, Richard J. Lessells, Jienchi Dorward, Mahomed Y.S. Moosa, Yukteshwar Sookrajh, Pravi Moodley, Paul K. Drain, Nigel Garrett | This work is licensed under CC Attribution 4.0
Submitted: 09 January 2025 | Published: 23 April 2025

About the author(s)

Kirusha Naidoo, Department of HIV Vaccines and Pathogenesis, Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
Richard J. Lessells, Department of HIV Vaccines and Pathogenesis, Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; and, KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
Jienchi Dorward, Department of HIV Vaccines and Pathogenesis, Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; and, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
Mahomed Y.S. Moosa, Department of Infectious Diseases, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
Yukteshwar Sookrajh, eThekwini Municipality Health Unit, Durban, South Africa
Pravi Moodley, Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa; and, Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
Paul K. Drain, Department of Epidemiology, University of Washington, Seattle, Washington, United States of America; and, Department of Global Health, University of Washington, Seattle, Washington, United States of America; and, Department of Medicine, University of Washington, Seattle, Washington, United States
Nigel Garrett, Department of HIV Vaccines and Pathogenesis, Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; and, Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa

Abstract

The integrase strand transfer inhibitor, dolutegravir (DTG), is widely used in first- and second-line antiretroviral therapy (ART) regimens in South Africa. We describe an adult with virological failure on second-line tenofovir/lamivudine/dolutegravir (TLD2) and rapid emergence of DTG resistance within 3 months, while receiving rifapentine-based tuberculosis preventive therapy.

Keywords

drug resistance; dolutegravir resistance; drug-drug interaction; dolutegravir; rifapentine.

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