Since 2018, WHO has recommended dolutegravir as the preferred first- and second-line HIV treatment for all populations.

Compared to other drugs, it is more effective, less addictive, and has fewer side effects.

It also has a high genetic barrier to the development of resistance.

However, among the four reported surveys, resistance to dolutegravir ranged from 3.9% to 8.6%, and reached 19.6% among people experienced with treatment and transitioned to a DTG-containing ART while having high HIV viral loads.

WHO recommends that countries systematically implement standard HIV surveillance to monitor the prevalence and patterns of drug resistance in people who do not achieve viral load suppression.

This report also documents cases of Integrase Strand Transfer Inhibitor (INSTI) resistance after recent exposure to Cabotegravir (CAB-LA).

A delay in detection and confirmation of HIV infection may increase the risk of developing INSTI resistance.

From 2022, WHO has recommended the use of long-acting injectable CAB-LA as an additional HIV prevention option for people at high risk of HIV infection.