High rates of transmitted NNRTI resistance in acute HIV-infection in Malawi

In a study from Malawi, samples from patients with acute
HIV-infection were tested for transmitted drug resistance.
Among 45 cases of acute HIV-infection, 9 (20 %) had at least
one NNRTI associated resistance mutation. There were also
3 cases of NRTI mutations. The most common mutation was
K103N.

Ref; Rutstein et al. AID Res Ther 2019; 10.1186/s12981-019-0220-8

Comment: WHO have recently recommended dolutegravir in
combination with 2 NRTIs as first line therapy for treatment
naïve individuals with HIV replacing NNRTIs. The increase
in transmitted NNRTI resistance in resource limited countries
like Malawi is an argument for switching first line therapy
away from NNRTIs to dolutegravir. Also in women of childbearing
potential the benefits of dolutegravir are likely to outweigh
the potential risks including the risk of neural tube defects according
to WHO.