Ndovu Study: Switching to DRV/r Recommended for DTG Resistance in Kenya

• Researchers presented three key studies on HIV care at the 26th International AIDS conference.
• The Ndovu study found that resistance to dolutegravir (DTG) is increasingly recognized due to its widespread use across sub-Saharan Africa.
• Switching to a ritonavir-boosted darunavir (DRV/r)-based regimen led to better viral suppression compared to continuing standard-dose DTG in the presence of major DTG-associated drug resistance mutations (DRMs).
• The Ndovu study's findings highlight the urgent need for better tools to identify DTG resistance and determine when patients should be switched to alternative treatment.
• Lawyers advising clients on HIV treatment in Kenya should be aware of these emerging trends and consider switching to alternative treatments like ritonavir-boosted darunavir when necessary.

The results also highlight the urgent need for better tools to identify DTG resistance and support timely, evidence-based treatment decisions, particularly in resource-limited settings.

Researchers at the Center for Epidemiological Modelling and Analysis (CEMA), University of Nairobi, Kenya, presented three key studies on HIV care at the 26th International AIDS conference. The Ndovu study, a multi-country prospective cohort study in Kenya, Tanzania, Mozambique, and Lesotho, examined the optimal approach to managing people experiencing treatment failure while on dolutegravir (DTG)-based treatment. The study found that resistance to DTG has historically been rare but is increasingly recognized due to its widespread use across sub-Saharan Africa.

The Ndovu study enrolled 2,994 participants in Kenya who were on DTG-based treatment for at least six months and identified those with major DTG-associated drug resistance mutations (DRMs). These participants were then randomized into a nested clinical trial to test the optimal management of people experiencing DTG treatment failure. The results showed that switching to a ritonavir-boosted darunavir (DRV/r)-based regimen led to better viral suppression compared to continuing standard-dose DTG.

The study's preliminary findings suggest that continuing standard-dose DTG in the presence of major DTG-associated DRMs is associated with a higher risk of virological failure, and switching to DRV/r is highly recommended. The results also highlight the urgent need for better tools to identify DTG resistance and determine when patients should be switched to alternative treatment.

The use of dolutegravir (DTG) as an antiretroviral therapy has become increasingly widespread across sub-Saharan Africa, leading to concerns about emerging drug resistance. The Ndovu study's findings on the optimal management of people experiencing DTG treatment failure have significant implications for HIV treatment policies in resource-limited settings. Lawyers advising clients on HIV treatment in Kenya should be aware of these emerging trends and consider switching to alternative treatments like ritonavir-boosted darunavir when necessary.

The Ndovu study's results also underscore the need for accessible tools to detect DTG resistance and support timely, evidence-based treatment decisions. In settings where drug resistance testing is not widely or routinely available, healthcare providers must rely on clinical judgment and experience to make informed treatment decisions. The Ndovu study's findings provide valuable insights into the management of people experiencing DTG treatment failure and highlight the importance of ongoing research in this area.

The Ndovu study's findings on the optimal management of people experiencing dolutegravir (DTG) treatment failure have significant implications for HIV treatment policies in Kenya and beyond. The study's results demonstrate that switching to a ritonavir-boosted darunavir (DRV/r)-based regimen leads to better viral suppression compared to continuing standard-dose DTG. This finding is particularly relevant in resource-limited settings where access to drug resistance testing may be limited.

The Ndovu study's findings also highlight the urgent need for better tools to identify DTG resistance and determine when patients should be switched to alternative treatment. By generating much-needed evidence on the management of people experiencing DTG treatment failure, the Ndovu study is helping to improve HIV treatment policies and outcomes in Kenya and across sub-Saharan Africa.

Lawyers advising clients on HIV treatment in Kenya should be aware of the emerging drug resistance to dolutegravir, a commonly used antiretroviral therapy, and consider switching to alternative treatments like ritonavir-boosted darunavir when necessary.

Source: Original reporting via Center for Epidemiological Modelling and Analysis (CEMA), University of Nairobi, Kenya