HIV-1 Resistance to Dolutegravir in Benin: The Need to Improve and Strengthen Therapeutic Patient Education Strategies to Achieve the Third Objective 95 of UNAIDS 95-95-95 Target.

Benin has adopted the WHO 2019 recommendations by integrating dolutegravir into the first- and second-line treatment regimen with regular monitoring of the emergence of resistance. The standard of care document has been updated, and healthcare staff have been trained on dosage, drug interactions, and the management of adverse effects. The patient, diagnosed as HIV-1 positive, was started on antiretroviral therapy, which had to be modified due to poor adherence. HIV-RNA was extracted from plasma with QIAGEN RNA kit, and nested polymerase chain reaction was performed in Reference National Laboratory of Health Program Fighting Against AIDS in Benin on the polymerase gene using the Applied Biosystems HIV-1 Genotyping Kit PR-RT with Integrase. Drug resistance mutations and the remaining effective antiretrovirals drug were identified using Stanford University Antiretroviral-Associated Resistance Mutation Interpretation Algorithm (https://hivdb.stanford.edu/ Version 9.8). The phylogenetic tree was constructed using SeaView with the maximum likelihood method and 1000 bootstrap iterations to identify the viral subtype along PR-RT and integrase gene. No PI-associated resistance mutations were observed. The NRTIs and NNRTIs associated resistance mutations were (M41 ML, D67G, S68G, K70R, M184 V, T215F, and K219E), (V179E and Y188 L), respectively. The major and accessory INSTI mutations observed were (E138 K, G140 GA, S147SG, Q148R, and N155H) and T97A, respectively. All protease inhibitors were effective against the identified HIV-1 viral strain which was a CRF02_AG along the polymerase gene. HIV-1 resistance genotyping can improve monitoring of the emergence of resistance in nonadherent individuals and anticipate early treatment failures in order to accelerate access to the third 95 of UNAIDS 95-95-95 target.