Emerging integrase strand transfer inhibitor drug resistance mutations among children and adults on ART in Tanzania: findings from a national representative HIV drug resistance survey.

This article focuses on the prevalence and patterns of acquired HIV drug resistance mutations (DRMs) among children and adults in Tanzania amid the rollout of dolutegravir, an integrase strand transfer inhibitor (INSTI), as part of antiretroviral therapy (ART). A national cross-sectional survey of 2039 people living with HIV (PLHIV) found that 71.5% of participants with high viral load (≥1000 copies/mL) harbored DRMs, with 5.8% exhibiting INSTI DRMs conferring resistance to dolutegravir. The study highlights concerns about dolutegravir resistance emerging particularly in patients switched from non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens without confirmed viral suppression, suggesting possible functional monotherapy due to pre-existing nucleoside reverse transcriptase inhibitor (NRTI) resistance. These findings underscore the importance of viral load testing and resistance monitoring before regimen switching to sustain ART effectiveness in Tanzania and similar resource-limited settings.