Viraemia and HIV drug resistance among people receiving dolutegravir versus efavirenz-based first-line antiretroviral therapy

Limited data exists to inform management of viraemia among people receiving dolutegravir-based first-line ART in low- and middle-income countries. Among South-Africans with viraemia ≥1000copies/mL receiving dolutegravir (n=43) and efavirenz (n=37), we found no dolutegravir resistance, but high efavirenz resistance (66.7%). 12-week resuppression was higher with dolutegravir (85%) versus efavirenz (38%). ### Competing Interest Statement Cepheid provided point-of-care VL assays at no cost for use at the study site. The authors have no other competing interests to declare. ### Funding Statement This work is supported by grants from the Wellcome Trust PhD Programme for Primary Care Clinicians (216421/Z/19/Z), the University of Oxford Research England QR Global Challenges Research Fund (0007365) and the Africa Oxford Initiative (AfiOx-119). HIV drug resistance testing and drug concentration testing was funded by the National Institute for Health and Care Research (NIHR) Community Healthcare MedTech and In Vitro Diagnostics Co-operative at Oxford Health NHS Foundation Trust (MIC-2016-018); GH, CCB & PJT also receive funding from this award. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Biomedical Research Ethics Committee (BREC 00000836/2019) of the University of KwaZulu-Natal and the University of Oxford Tropical Research Ethics Committee (OxTREC 66-19) gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Bona fide researchers will be able to request access to anonymised trial data by contacting the corresponding author. * ART : antiretroviral therapy PLHIV : people living with HIV LMIC : low- and middle-income countries UNAIDS : Joint United Nations Programme on HIV/AIDS WHO : World Health Organization