Dolutegravir Resistance and Its Interaction with RTI Resistance

Antiretroviral treatment (ART) failure in patients treated with the HIV integrase inhibitor (INI) dolutegravir has infrequently been associated with INI resistance — in contrast to the findings for the two previously developed INIs, raltegravir and elvitegravir. In clinical trials, no cases of INI resistance were noted among ART-naive patients initiating dolutegravir-based regimens. In vitro selection studies have identified the emergence over time of the integrase mutation R263K, a mutation also detected in two of the four cases of INI resistance reported among ART-experienced patients with treatment failure while taking dolutegravir as a first INI-based regimen. Noting that resistance to reverse transcriptase inhibitors (RTIs), too, has b…