{
  "abstract": "Background\n\nAfrica remains a major epicentre of the global HIV epidemic, with Central Africa exhibiting extensive HIV-1 genetic diversity that may influence the emergence and transmission of drug resistance mutations. Following World Health Organization recommendations, Angola initiated the national transition to dolutegravir (DTG)-based antiretroviral therapy (ART) in 2021. This study evaluated the frequency, patterns and temporal trends of HIV-1 drug resistance mutations before and after DTG implementation (2019-23), while also characterizing HIV-1 genetic diversity across Angolan provinces outside Luanda.Methods\n\nA retrospective observational analytical study comparing pre- and post-Integrase strand transfer inhibitor (INSTI) introduction periods was conducted using plasma samples and dried blood spot cards from 17 provinces of Angola.Results\n\nOf the 201 samples analysed, 102 were successfully sequenced for at least one coding region [protease (n = 65); reverse transcriptase (n = 66); integrase (IN) (n = 86)], comprising 48 INSTI-naive people living with HIV and 54 INSTI-experienced people living with HIV samples. Subtype C was the most prevalent (21.6%), followed by unique recombinant forms (20.6%), A1 (15.7%), F1 (13.7%), CRF02_AG (10.8%), G (8.8%) and other subtypes or recombinants (8.8%). Resistance to non-nucleoside reverse transcriptase inhibitors was the most common (68.2%; 95% CI 56.2-78.2), followed by nucleoside reverse transcriptase inhibitors (48.5%; 95% CI 36.8-60.3). Resistance to protease inhibitors (PIs) and INSTIs was lower, observed in 1.5% (95% CI 0.3-8.2) and 3.5% (95% CI 1.2-9.8), respectively.Conclusions\n\nIn this analysis, substantial HIV-1 genetic and epidemiological complexity was observed. In the context of the rapid scale-up of DTG-based ART, continued surveillance of INSTI resistance mutations has become increasingly important to inform evidence-based public health strategies aimed at preventing the transmission of drug-resistant HIV strains and optimizing ART regimens at the population level.",
  "abstract_shown": true,
  "affiliations": [
    "Instituto Nacional de Luta Contra SIDA (INLS), Ministério da Saúde, Luanda, Angola.",
    "Global Health and Tropical Medicine, GHTM, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, Lisboa, Portugal.",
    "Tufts University School of Medicine, Boston, MA, USA.",
    "Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz, Rio de Janeiro 21045-900, Brazil.",
    "Instituto Adolfo Lutz, Centro de Virologia, São Paulo, SP, Brazil.",
    "Amsterdam Institute for Global Health and Development, and Department of Global Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 20,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Bárbara Pocongo",
      "orcid": "0009-0001-5189-0977"
    },
    {
      "affs": [
        0
      ],
      "name": "Maria Furtado"
    },
    {
      "affs": [
        0
      ],
      "name": "Cláudia Bernardi"
    },
    {
      "affs": [
        0
      ],
      "name": "Lucrécia Jacinto"
    },
    {
      "affs": [
        0
      ],
      "name": "Aulória José"
    },
    {
      "affs": [
        0
      ],
      "name": "Jaime Urica"
    },
    {
      "affs": [
        0
      ],
      "name": "Rosa Torres"
    },
    {
      "affs": [
        0
      ],
      "name": "Francisco Vunge"
    },
    {
      "affs": [
        1
      ],
      "name": "Beatriz Almeida"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Michael R Jordan"
    },
    {
      "affs": [
        3
      ],
      "name": "Carlos Jesus"
    },
    {
      "affs": [
        3
      ],
      "name": "Monick Lindenmeyer Guimarães"
    },
    {
      "affs": [
        4
      ],
      "name": "Cíntia Mayumi Ahagon"
    },
    {
      "affs": [
        4
      ],
      "name": "Giselle Lopes"
    },
    {
      "affs": [
        4
      ],
      "name": "Luís Brígido"
    },
    {
      "affs": [
        5
      ],
      "name": "Seth Inzaule",
      "orcid": "0000-0002-0155-7391"
    },
    {
      "affs": [
        1
      ],
      "name": "Ana B Abecasis"
    },
    {
      "affs": [
        1
      ],
      "name": "Ricardo Parreira"
    },
    {
      "affs": [
        1
      ],
      "name": "João Piedade"
    },
    {
      "affs": [
        1
      ],
      "name": "Victor Pimentel"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/ayeffqvnyt433.bib",
  "cited_by": 0,
  "doi": "10.1093/jac/dkag355",
  "fulltext_url": "https://europepmc.org/articles/PMC13729367",
  "id": "ayeffqvnyt433",
  "issns": [
    "0305-7453",
    "1460-2091"
  ],
  "landing_url": "https://europepmc.org/article/MED/42975147",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2725|HIV/AIDS drug development and treatment"
    ]
  ],
  "openalex": "W7225204213",
  "pdf_url": "https://europepmc.org/articles/PMC13729367?pdf=render",
  "pmcid": "PMC13729367",
  "pmid": "42975147",
  "published": "2026-11-01",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/ayeffqvnyt433.ris",
  "sources": [
    {
      "first_seen": "2026-11-04T15:20:47Z",
      "native_id": "MED:42975147",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42975147"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2725|HIV/AIDS drug development and treatment",
      "subfield": "infectious-disease"
    }
  ],
  "title": "Understanding integrase inhibitor resistance in Angola: a comparative analysis of INSTI-naive and INSTI-experienced individuals.",
  "title_text": "Understanding integrase inhibitor resistance in Angola: a comparative analysis of INSTI-naive and INSTI-experienced individuals.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-05T03:20:59Z",
  "url": "https://research.draconitic.com/paper/ayeffqvnyt433",
  "venue": "The Journal of antimicrobial chemotherapy",
  "versions": []
}