ArticleJournal of the International AIDS Society2026
Emerging Dolutegravir Resistance Among Children on Antiretroviral Therapy With Virological Failure in Malawi: Results From a 2023 National Cross-Sectional Survey.
Article in Journal of the International AIDS Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
26 authors.
Funding
Abstract
introductionMalawi began transitioning children living with HIV (CLHIV) to dolutegravir-based regimens (DBRs) in 2020, and 99.9% were on a DBR by September 2023. With nearly universal use of DBR, surveillance of HIV drug resistance (HIVDR) to dolutegravir is essential. We describe the prevalence and patterns of HIVDR among CLHIV on DBR with confirmed virological failure (viral load [VL] twice ≥1000 copies/mL).
methodsWe randomly selected 19 of the 25 highest-volume ART health facilities in Malawi for participant enrolment between July 2022 and February 2023. Enrolment criteria included CLHIV aged 2-14 years, on a DBR for ≥9 months and VL ≥1000 copies/mL. Sanger HIVDR genotyping was performed if a repeat VL result post-intensive adherence counselling was ≥1000 copies/mL. The Stanford University HIVDR Database was used for drug resistance interpretation. We present weighted HIVDR prevalence estimates with 95% confidence limits accounting for correlation within clinics.
resultsOf 302 CLHIV enrolled, 133 (44%) had confirmed virological failure. The weighted prevalence of dolutegravir resistance among CLHIV with confirmed virological failure was 15.6% (95% CI: 7.1-24.0%), with the presence of major dolutegravir drug resistance mutations (DRMs) in 14.2% (95% CI: 4.8-23.6). The most common dolutegravir DRMs were R263K (n = 11) and G118R (n = 4). Weighted prevalence rates of resistance to nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors were 42.2%, 65.5% and 5.0%, respectively. Three children had HIVDR to all four drug classes.
conclusionsDolutegravir resistance was found in nearly one in six Malawian CLHIV with confirmed virological failure on DBRs. This raises concerns for treatment options in this vulnerable population, given the coexistence of high prevalence of resistance to NRTIs and NNRTIs. These results point to the need for regular HIVDR surveillance and further research to guide genotyping prioritization and next-line treatment strategies.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.