HIV-1 diversity and the implementation of integrase strand-transfer inhibitors as part of combination antiretroviral therapy

Abstract

: The integrase (IN) strand-transfer inhibitor (InSTI) dolutegravir (DTG) is now recommended by the World Health Organization as part of salvage and/or first-line combination antiretroviral therapy (cART).[1] DTG has a high genetic barrier against developing resistance and is effective against all strains that previously exhibited resistance-associated mutations (RAMs) against other cART regimens.[2] Recommendations to use DTG were delayed owing to preliminary findings from Botswana that indicated potential safety concerns in pregnancy, with a small increased risk of neural tube defects.[3] Studies that investigated the safety and efficacy of DTG now support its use in all populations, including pregnant women and those of childbearing potential