Background: In late 2018, Cuba incorporated Dolutegravir, a second-generation integrase inhibitor (INSTI), into its first-line antiretroviral treatment regimens. Monitoring HIV-1 drug resistance in patients with virological failure is critical for optimizing HIV care and treatment outcomes. This study assessed the prevalence of INSTI resistance among adults experiencing virological failure while receiving Dolutegravir-based ART in Cuba. Methods: Cross-sectional analysis using programmatic data from eight healthcare facilities, representing approximately 78% of adults receiving ART in Cuba. Adults (≥18 years) receiving all individuals receiving a Dolutegravir-based ART, who presented a confirmed virological failure (two consecutive viral loads >1000 copies/mL at least three months apart) between June 2022 and December 2024, were included. Demographic and clinical data were extracted from standardized laboratory requisition forms. Blood specimens were collected for HIV drug resistance and tested by Sanger sequencing, with resistance predicted using the Stanford HIVdb tool. Results: Among 110 eligible adults, 9 (8.2%) showed INSTI resistance-associated mutations, but only 6 had high level of resistance to Dolutegravir. Acquired HIV-1 drug resistance of any type was identified in 50.0% of patients (95% CI, 40·3–59·7). Additionally, 28.2% (95% CI, 20.6–37.2) carried mutations associated with resistance to non-nucleoside reverse transcriptase inhibitors and 18·2% (95% CI, 11.5-26.7) to nucleoside reverse transcriptase inhibitors. Two patients (1.8%) were found to have multidrug-resistant virus. Conclusions: The low prevalence of Dolutegravir resistance among patients with virological failure suggests that poor adherence, rather than antiviral resistance, may be the primary contributor to unsuppressed viral load in this population. These findings underscore the need to strengthen adherence support, alongside continued surveillance to promptly detect emerging resistance.
| Published in | International Journal of Infectious Diseases and Therapy (Volume 11, Issue 1) |
| DOI | 10.11648/j.ijidt.20261101.11 |
| Page(s) | 1-8 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2026. Published by Science Publishing Group |
Acquired Resistance, Dolutegravir, HIV, Cuba
| [1] | World Health Organization. Guidelines HIV Prevention, testing, treatment, service delivery and monitoring: Recommendation for Public Health Approach 2021: 148-82. |
| [2] | Gupta RK, Gregson J, Parkin N, Haile-Selassile H, Tanuri H, Andrade Forrero L, et al. HIV-1 drug resistance before initiation or re-initiation of first line-antiretroviral therapy in low-income and middle income countries. A systematic review and meta-regression analysis. Lancet Infect Dis 2018; 18: 346-355. |
| [3] | Frescura L, Godfrey-Faussett P, Feizzadell AA, El-Sard W, Syanf O, Ghys PD, et al. Achieving the 95-95-95 targets for all: A pathway to ending to AIDS. Plos ONE 2022; 17(8): e0272405. |
| [4] | World Health Organization. Global Action Plan on HIV Drug Resistance 2017-2021. World Health Organization, Geneva, Switzerland, 2017. |
| [5] | Machado LY, Blanco M, López LS, Díaz HM, Dubed M, Valdés N, et al. National survey of pre-treatment HIV drug resistance in Cuban patients. Plos ONE 2019; 14(9): e0221879. |
| [6] | Veloso Meireles M, Pascom ARP, Duarte EC, McFarland W. Comparative effectiveness of first-line antiretroviral therapy: results from a large real-world cohort after the implementation of Dolutegravir. AIDS 2019, Aug 1; 33(10): 1663-1668. |
| [7] | Bernabé KJ, Siedner M; Tsai AC, Marconi VC, Murphy RA. Detection of HIV Virologic Failure and Switch to Second Line therapy: A systematic review and meta-analysis of data from Sub-Saharan Africa. Open Forum Infect. Dis 2022; 9, ofac 121. |
| [8] | HIV Drug Resistance: Brief Report 2024. World Health Organization: Geneva, Switzerland, 2024. Licence: CC BY-NC-SA 3.0 IGO. |
| [9] | Plan Estratégico Nacional para la prevención y control de las ITS, el VIH y las hepatitis. 2019–2023. Ministerio de Salud Pública, República de Cuba. ISBN: 978-959-283-180-3. |
| [10] | Alemán Y, Vinken L, Kourí V, Pérez L, Álvarez A, Abrahantes Y, et al. Performance of an In-House Human Immunodeficiency Virus Type 1 Genotyping System for Assessment of Drug Resistance in Cuba. PLoS ONE 2015; 10(2): e0117176. |
| [11] | Van-Laethem K, Schorooten Y, Covens K, Debeersmaeker N, de Munter P, Van Wjngaerden E, et al. A genotypic assay for the amplification and sequencing of integrase from diverse HIV-1 group M subtypes. Journal of Virological Methods 2008; 153: 176-181. |
| [12] | Kourí V, Alemán Y, Pérez L, Pérez J, Fonseca C, Correa C et al. High frequency of antiviral drug resistance and non-B subtypes in HIV-1 patients failing antiviral therapy in Cuba. Journal of Clinical Virology 2012, 55: 348-355. |
| [13] | Alemán Y, Kourí V, Pérez L, Fonseca C, Pérez J, Ortega L, et al. HIV-1 antiretroviral resistance in Cuba, 2009-2014. MEDICC Review 2018; 20(3): 15-21. |
| [14] | Bwire GM, Godwin Aiko B, Musha IM, Kilapilo MS, Mangora A, Kazonda P, et al. High viral suppression and detection of Dolutegravir-resistance associated mutations in treatment experience Tanzanian adults living with HIV-1 in Dar es Salaam. Scientific Reports 2023; 13: 20493. |
| [15] | Inzaule S, Bertagnolio S, Kityo C M, Siwale M, Akanmu S; Wellington M, et al. The relative contributions of HIV drug resistance, non adherence and low-level viremia to viremic episodes on antiretroviral therapy in sub-Saharan Africa. AIDS 2020; 34(10): 1559-1566. |
| [16] | Pintos-Saavedra Y, Pérez L, Kourí-Cardellá V, González MM, Pintos J, Ávila JP, Gomez CF, et al. Primary and secondary resistance of HIV-1 to integrase inhibitors in Cuban patients infected with multidrug-resistant HIV strains. J Microbiol Infect Dis. 2023; 13(2): 72-81. |
| [17] | Inzaule S, Hamers R, Noguera-Julian M, Casadellá M, Parera M, Rinke de Wit T, et al. Primary resistance to integrase strand transfer inhibitors in patients infected with diverse HIV-1 subtypes in sub-Saharan Africa, Journal of Antimicrobial Chemotherapy 2018; 73(5): 1167–1172. |
| [18] | Joep J van Oosterhout, Chifundo Chipungu, Lyse Nkhoma, Hope Kanise, Mina C Hosseinipour, Jean Babtiste Sagno, et al. Dolutegravir Resistance in Malawi’s National HIV Treatment Program, Open Forum Infectious Diseases 2022; 9(5). |
| [19] | Kouri V, Khouri R, Alemán Y, Abrahantes Y, Vercauteren J, Pineda-Peña AC, et al. CRF19_cpx is an Evolutionary fit HIV-1 Variant Strongly Associated With Rapid Progression to AIDS in Cuba. EBioMedicine. 2015 Jan 28; 2(3): 244-54. |
| [20] | Suárez A, Pérez L, Machado LY, Méndez M; Pintos Y, Pérez J, et al. Tropism prediction in HIV-1 variants circulating in Cuba, 2017-2019: Implications for the pathogenesis of infection and response to Maraviroc. J. Microbiol. Infect. Dis 2023, 3(2): 59-71. |
APA Style
Machado, L. Y., Blanco, M., Mesa, A., Díaz, H. M., Dubed, M., et al. (2026). Prevalence of Dolutegravir Resistance Among Adults Receiving Dolutegravir-based Antiretroviral Therapy with Virological Failure in Cuba. International Journal of Infectious Diseases and Therapy, 11(1), 1-8. https://doi.org/10.11648/j.ijidt.20261101.11
ACS Style
Machado, L. Y.; Blanco, M.; Mesa, A.; Díaz, H. M.; Dubed, M., et al. Prevalence of Dolutegravir Resistance Among Adults Receiving Dolutegravir-based Antiretroviral Therapy with Virological Failure in Cuba. Int. J. Infect. Dis. Ther. 2026, 11(1), 1-8. doi: 10.11648/j.ijidt.20261101.11
@article{10.11648/j.ijidt.20261101.11,
author = {Liuber Yans Machado and Madeline Blanco and Adriana Mesa and Héctor Manuel Díaz and Marta Dubed and Neisy Valdés and Karen Valdés and Liodelvio Martínez and Niurka Ramos and Amalia Girón and Mireida Rodríguez and Manuel Romero and Betsy Benítez and María Lourdes Sánchez and René Rodríguez and Omar Sued},
title = {Prevalence of Dolutegravir Resistance Among Adults Receiving Dolutegravir-based Antiretroviral Therapy with Virological Failure in Cuba},
journal = {International Journal of Infectious Diseases and Therapy},
volume = {11},
number = {1},
pages = {1-8},
doi = {10.11648/j.ijidt.20261101.11},
url = {https://doi.org/10.11648/j.ijidt.20261101.11},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijidt.20261101.11},
abstract = {Background: In late 2018, Cuba incorporated Dolutegravir, a second-generation integrase inhibitor (INSTI), into its first-line antiretroviral treatment regimens. Monitoring HIV-1 drug resistance in patients with virological failure is critical for optimizing HIV care and treatment outcomes. This study assessed the prevalence of INSTI resistance among adults experiencing virological failure while receiving Dolutegravir-based ART in Cuba. Methods: Cross-sectional analysis using programmatic data from eight healthcare facilities, representing approximately 78% of adults receiving ART in Cuba. Adults (≥18 years) receiving all individuals receiving a Dolutegravir-based ART, who presented a confirmed virological failure (two consecutive viral loads >1000 copies/mL at least three months apart) between June 2022 and December 2024, were included. Demographic and clinical data were extracted from standardized laboratory requisition forms. Blood specimens were collected for HIV drug resistance and tested by Sanger sequencing, with resistance predicted using the Stanford HIVdb tool. Results: Among 110 eligible adults, 9 (8.2%) showed INSTI resistance-associated mutations, but only 6 had high level of resistance to Dolutegravir. Acquired HIV-1 drug resistance of any type was identified in 50.0% of patients (95% CI, 40·3–59·7). Additionally, 28.2% (95% CI, 20.6–37.2) carried mutations associated with resistance to non-nucleoside reverse transcriptase inhibitors and 18·2% (95% CI, 11.5-26.7) to nucleoside reverse transcriptase inhibitors. Two patients (1.8%) were found to have multidrug-resistant virus. Conclusions: The low prevalence of Dolutegravir resistance among patients with virological failure suggests that poor adherence, rather than antiviral resistance, may be the primary contributor to unsuppressed viral load in this population. These findings underscore the need to strengthen adherence support, alongside continued surveillance to promptly detect emerging resistance.},
year = {2026}
}
TY - JOUR T1 - Prevalence of Dolutegravir Resistance Among Adults Receiving Dolutegravir-based Antiretroviral Therapy with Virological Failure in Cuba AU - Liuber Yans Machado AU - Madeline Blanco AU - Adriana Mesa AU - Héctor Manuel Díaz AU - Marta Dubed AU - Neisy Valdés AU - Karen Valdés AU - Liodelvio Martínez AU - Niurka Ramos AU - Amalia Girón AU - Mireida Rodríguez AU - Manuel Romero AU - Betsy Benítez AU - María Lourdes Sánchez AU - René Rodríguez AU - Omar Sued Y1 - 2026/01/07 PY - 2026 N1 - https://doi.org/10.11648/j.ijidt.20261101.11 DO - 10.11648/j.ijidt.20261101.11 T2 - International Journal of Infectious Diseases and Therapy JF - International Journal of Infectious Diseases and Therapy JO - International Journal of Infectious Diseases and Therapy SP - 1 EP - 8 PB - Science Publishing Group SN - 2578-966X UR - https://doi.org/10.11648/j.ijidt.20261101.11 AB - Background: In late 2018, Cuba incorporated Dolutegravir, a second-generation integrase inhibitor (INSTI), into its first-line antiretroviral treatment regimens. Monitoring HIV-1 drug resistance in patients with virological failure is critical for optimizing HIV care and treatment outcomes. This study assessed the prevalence of INSTI resistance among adults experiencing virological failure while receiving Dolutegravir-based ART in Cuba. Methods: Cross-sectional analysis using programmatic data from eight healthcare facilities, representing approximately 78% of adults receiving ART in Cuba. Adults (≥18 years) receiving all individuals receiving a Dolutegravir-based ART, who presented a confirmed virological failure (two consecutive viral loads >1000 copies/mL at least three months apart) between June 2022 and December 2024, were included. Demographic and clinical data were extracted from standardized laboratory requisition forms. Blood specimens were collected for HIV drug resistance and tested by Sanger sequencing, with resistance predicted using the Stanford HIVdb tool. Results: Among 110 eligible adults, 9 (8.2%) showed INSTI resistance-associated mutations, but only 6 had high level of resistance to Dolutegravir. Acquired HIV-1 drug resistance of any type was identified in 50.0% of patients (95% CI, 40·3–59·7). Additionally, 28.2% (95% CI, 20.6–37.2) carried mutations associated with resistance to non-nucleoside reverse transcriptase inhibitors and 18·2% (95% CI, 11.5-26.7) to nucleoside reverse transcriptase inhibitors. Two patients (1.8%) were found to have multidrug-resistant virus. Conclusions: The low prevalence of Dolutegravir resistance among patients with virological failure suggests that poor adherence, rather than antiviral resistance, may be the primary contributor to unsuppressed viral load in this population. These findings underscore the need to strengthen adherence support, alongside continued surveillance to promptly detect emerging resistance. VL - 11 IS - 1 ER -