ArticleSouthern African journal of infectious diseases2026
R263K-associated dolutegravir resistance on tenofovir, lamivudine and dolutegravir: Implications for earlier genotyping and regimen optimisation.
Article in Southern African journal of infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Abstract
A South African woman receiving tenofovir, lamivudine and dolutegravir (TLD) with good adherence, developed virological failure with the integrase mutation R263K. Viral suppression was achieved after rapid intensification to dolutegravir 50 mg twice daily combined with atazanavir with ritonavir (ATV/r), with continuation of the nucleoside backbone (dual-anchor regimen). This case highlights the need for earlier resistance testing and specialist-guided salvage therapy for subtype C in resource-limited settings. Contribution: Archived nucleoside reverse transcriptase inhibitor (NRTI) resistance may render the background drugs functionally inactive, creating functional DTG monotherapy that can select for R263K in HIV-1 subtype C. Swift escalation to salvage therapy may mitigate viraemia. Algorithms should be formulated to warrant earlier genotyping and promote rapid efforts to limit resistance accumulation in patients with documented adherence.
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