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Case Report
Rapid development of drug resistance during initial dolutegravir-based antiretroviral therapy of an infant with HIV
Southern African Journal of HIV Medicine | Vol 26, No 1 | a1750 |
DOI: https://doi.org/10.4102/sajhivmed.v26i1.1750
| © 2025 Natasha L. O’Connell, Tara-Lee von Mollendorff, Gert van Zyl, Stephen Korsman, James Nuttall
| This work is licensed under CC Attribution 4.0
Submitted: 23 June 2025 | Published: 09 October 2025
Submitted: 23 June 2025 | Published: 09 October 2025
About the author(s)
Natasha L. O'Connell, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South AfricaTara-Lee von Mollendorff, Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Gert van Zyl, Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; and National Health Laboratory Service, Tygerberg Business Unit, Cape Town, South Africa
Stephen Korsman, Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
James Nuttall, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Abstract
Dolutegravir resistance is predominantly reported in antiretroviral therapy-experienced individuals. We describe an infant who developed high-level resistance to abacavir, lamivudine, and dolutegravir within 97 days of initiation, despite initial wild-type infection. Causative factors likely include probable sub-therapeutic antiretroviral drug levels, poor tolerance, severe immunocompromise, and a high pre-treatment viral load.
What this study adds: The evolution of DTG resistance from a confirmed transmitted wild-type virus in this infant is more rapid than previously described. Identification of risk factors for developing DTG resistance in infants requires further investigation.
Keywords
children; HIV; drug resistance; dolutegravir; virological failure; perinatal transmission.
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