Virological Outcomes and Dolutegravir Resistance Mutations in HIV-infected Patients: A Multicenter Retrospective Cohort Study in Mozambique

Introduction The global HIV epidemic remains a public health challenge. Dolutegravir (DTG) has become a cornerstone of antiretroviral therapy (ART) regimens due to its efficacy and tolerability. However, the emergence of DTG resistance is a concern. This study aims to evaluate virological outcomes and the emergence of resistance mutations in patients treated with DTG in Mozambique. Methods A retrospective cohort study was conducted in seven DREAM centers in Mozambique. Data were collected from electronic medical records of patients on DTG-based ART between July-2022 and December-2023. Virological suppression rates, patient demographics and clinical characteristics, and the prevalence of resistance mutations were analyzed. Results A total of 29,601 patients were included, 98.1% (29,051 patients) were on DTG-based ART. The overall virological suppression rate among patients on DTG was 95% (27,622/29,051). Multivariate logistic regression analysis identified the following factors independently associated with virological suppression: older patients (aged > 50 years) had higher odds of achieving virological suppression (OR: 2.45, 95% CI: 1.85–3.26, p < 0.001), longer duration on ART (> 5 years) was also associated with suppression (OR: 1.92, 95% CI: 1.44–2.58, p < 0.001), female patients had higher odds of suppression (OR: 0.85, 95% CI: 0.75–0.97, p = 0.02), and patients treated in Quelimane City had lower odds of suppression compared to those in Machava (OR: 0.67, 95% CI: 0.52–0.86, p = 0.01). Of the 74 samples sent for resistance testing, 17 were analyzed for DTG resistance, and 8 displayed resistance major mutations. The most common mutations identified were G118R and E138K, variably associated with other major mutations. Conclusions This study demonstrates the effectiveness of DTG within the DREAM program in Mozambique, with a high rate of virological suppression. However, the emergence of resistance mutations underscores the need for ongoing monitoring and surveillance to optimize treatment outcomes and preserve the efficacy of DTG.