ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2026
Approaches to the Management of Virologic Failure on Dolutegravir-Based Antiretroviral Therapy in the 50 Countries With the Highest Adult HIV Prevalence.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2citing papers in PubMed
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1 · What the graph read from it
What it found
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2 · The registry
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5 · Who and what money
Authors and funding
15 authors.
Cameron T NuttMedical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
Richard J LessellsDepartment of Infectious Diseases, University of KwaZulu-Natal, Durban, South Africa.ORCID 0000-0003-0926-710X
Winnie R MuyindikeFaculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.ORCID 0000-0002-6694-2645
Lyra S JohnsonMedical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA.ORCID 0009-0006-5493-4484
Roger D KouyosDepartment of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland.ORCID 0000-0002-9220-8348
Tom LoosliDepartment of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland.ORCID 0000-0003-2049-3562
Loice Achieng OmbajoDepartment of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya.ORCID 0000-0003-4632-8792
Jaysingh BrijkumarDepartment of Infectious Diseases, University of KwaZulu-Natal, Durban, South Africa.
Emily P HyleMedical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA.ORCID 0000-0001-8721-106X
Mahomed-Yunus S MoosaDepartment of Infectious Diseases, University of KwaZulu-Natal, Durban, South Africa.ORCID 0000-0001-6191-4023
Monica GandhiDivision of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, USA.ORCID 0000-0001-6674-5388
Marco Antonio De Avila VitoriaGlobal HIV, Hepatitis, and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland.ORCID 0000-0002-1687-6723
Michael R JordanDepartment of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.
Mark J SiednerMedical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
Suzanne M McCluskeyMedical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
Funding
The impact of HIV viral diversity and cellular immunity on HIV pathogenesisP30AI060354 · NIAID · HARVARD UNIVERSITY (MEDICAL SCHOOL) · PI ARTHUR Y KIM · 2004 to 2026
$94.4M
Optimizing HIV Care in Less Developed CountriesR01AI058736 · NIAID · MASSACHUSETTS GENERAL HOSPITAL · PI Kenneth Alan Freedberg, Emily Parker Hyle · 2004 to 2026
$21.5M
Multidisciplinary HIV Training ProgramT32AI007387 · NIAID · MASSACHUSETTS GENERAL HOSPITAL · PI Daniel R. Kuritzkes · 1990 to 2026
$8.8M
Optimizing HIV Care in Less Developed CountriesR37AI058736 · NIAID · MASSACHUSETTS GENERAL HOSPITAL · PI FREEDBERG, KENNETH ALAN · 2018 to 2024
$6.6M
Randomized Trial to Optimize Virologic Suppression Rates Using a Point-of-Care Urine Monitoring Assay (ROVING-PUMA)R01AI143340 · NIAID · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Monica Gandhi · 2018 to 2026
$5.6M
A Randomized Clinical Trial to Evaluate Solutions for the Management of Virologic Failure for Individuals on TLD in Sub-Saharan AfricaR01AI167699 · NIAID · MASSACHUSETTS GENERAL HOSPITAL · PI Suzanne McCluskey · 2022 to 2026
$3.4M
HIV-1 subtype-specific drug resistance in patients failing Dolutegravir-based 1st, 2nd or 3rd line regimens: the International epidemiological Databases to Evaluate AIDS (IeDEA)R01AI152772 · NIAID · UNIVERSITY OF ZURICH · PI Roger Dimitri Kouyos · 2021 to 2026
$3.2M
“Hair Lengthening”: Using Hair Levels to Interpret Long-Acting PrEP Studies.R37AI098472 · NIAID · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Monica Gandhi · 2023 to 2026
$3.2M
Triaging dolutegravir resistance via a point-of-care urine tenofovir assayR01AI191753 · NIAID · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Monica Gandhi, MOSES Robert KAMYA · 2025 to 2026
$1.4M
FICHarvard Center for AIDS Research P30AI060354Jerome and Celia Reich Endowed Scholar R01AI143340Jerome and Celia Reich Endowed Scholar R01AI167699Jerome and Celia Reich Endowed Scholar R37AI098472NCINHLBINIANIAID NIH HHS L30 AI186161NIAID NIH HHS P30 AI060354NIAID NIH HHS R01 AI058736NIAID NIH HHS R01 AI143340NIAID NIH HHS R01 AI152772NIAID NIH HHS R01 AI167699NIAID NIH HHS R01 AI191753NIAID NIH HHS R37 AI058736NIAID NIH HHS R37 AI098472NIAID NIH HHS T32 AI007387NIAID NIH HHS T32AI007387NICHDNIDANIDCRNIDDKNIH HHSNIMHNIMHDNINROAR R01AI152772OAR R01AI167699Swiss National Science Foundation 324730_207957Swiss National Science Foundation R01AI152772Swiss National Science Foundation R37AI058736World Health Organization 001
6 · The paper itself
Abstract
Expanded access to dolutegravir as part of a fixed-dose combination with tenofovir disoproxil fumarate and lamivudine (TLD) has revolutionized global human immunodeficiency virus (HIV) treatment, with more than 25 million people prescribed this regimen in 2024. We reviewed national clinical guidelines for management of virologic failure on first-line TLD in the 50 countries with the highest prevalence of HIV among adults; recent guidelines were not available online for four. Among the remaining 46 country guidelines, we identified four distinct approaches: (1) empiric switch to a protease inhibitor (PI)-based regimen without genotypic resistance testing (GRT) (n = 28; 61%); (2) GRT to guide antiretroviral therapy selection (n = 14; 30%); (3) continuation of TLD without GRT (n = 3; 7%); and (4) empiric switch to a PI-based regimen with concurrent GRT (n = 1; 2%). The diversity of guideline-endorsed approaches underscores the critical need for additional data to inform policy regarding this important clinical scenario.
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.
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