HIV resistance in patients with virological failure to single tablet regimen: Roles of second generation integrase strand transfer inhibitors (INSTIs)
- 1Division of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
Abstract
Background: Limited clinical data are available on the prevalence of HIV resistance, especially for patients experiencing virological failure with integrase strand transfer inhibitors (INSTI) in an area with universal implementation of single tablet regimen (STR) as the first-line therapy. Methods: This multicenter retrospective study was conducted in Taiwan between 2015 and 2023. Clinical samples were obtained nationwide from patients experiencing failure of a STR requested for genotypic drug resistance testing at our reference laboratory. Virological failure was defined as a plasma viral load ≧ 1000 copies/ml. Logistic regression analysis was used to identify the factors associated with INSTI failure. Results: A total of 216 patients failed to STRs, of whom 99 failed on INSTIs-based STRs. Among these, 26 were treatment naïve with INSTI-based STR failure and 73 experienced virological failure after switching to INSTI-based STRs. Multivariable logistic regression analysis for the primary outcome revealed that PLHIV with INSTI-based STR failure were independently associated with previous exposure to first-generation INSTIs (adjusted OR 9.470, 95% CI: 3.880–23.115, p < 0.001), a non-MSM transmission route (adjusted OR 0.252, 95% CI: 0.098–0.649, p = 0.004) and current regimen> 12 months before genotypic resistance testing (adjusted OR 2.015, 95% CI: 1.067–3.805, p = 0.031). For the secondary outcomes, 24.4% (19/78) of tested PLHIV exhibited INSTI resistance at failure. Multivariable analysis showed that PLHIV failing EVG/COBI/TAF/FTC were significantly more likely to develop INSTI resistance (adjusted OR 22.75, 95% CI 2.114–244.868, p = 0.01) compared to BIC/TAF/FTC failures Conclusions: Virological failure on INSTI-based STRs in Taiwan is primarily driven by prior exposure to first-generation INSTIs. None of the treatment naïve patients with DTG or BIC-based STR failure developed INSTI resistance, but it is highly prevalent in patients failing first-generation INSTIs, such as EVG/COBI/TAF/FTC.
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BibTeX
@article{tsai2026resistance,
title = {{HIV resistance in patients with virological failure to single tablet regimen: Roles of second generation integrase strand transfer inhibitors (INSTIs)}},
author = {Hung-Chin Tsai and I-Tzu Chen and Hui-Min Chang},
journal = {Journal of Infection and Public Health},
year = {2026},
month = oct,
doi = {10.1016/j.jiph.2026.103385},
url = {https://doi.org/10.1016/j.jiph.2026.103385},
note = {CC BY},
}
RIS
TY - JOUR
TI - HIV resistance in patients with virological failure to single tablet regimen: Roles of second generation integrase strand transfer inhibitors (INSTIs)
AU - Hung-Chin Tsai
AU - I-Tzu Chen
AU - Hui-Min Chang
PY - 2026
DA - 2026/10/30
JO - Journal of Infection and Public Health
DO - 10.1016/j.jiph.2026.103385
UR - https://doi.org/10.1016/j.jiph.2026.103385
AB - Background: Limited clinical data are available on the prevalence of HIV resistance, especially for patients experiencing virological failure with integrase strand transfer inhibitors (INSTI) in an area with universal implementation of single tablet regimen (STR) as the first-line therapy. Methods: This multicenter retrospective study was conducted in Taiwan between 2015 and 2023. Clinical samples were obtained nationwide from patients experiencing failure of a STR requested for genotypic drug resistance testing at our reference laboratory. Virological failure was defined as a plasma viral load ≧ 1000 copies/ml. Logistic regression analysis was used to identify the factors associated with INSTI failure. Results: A total of 216 patients failed to STRs, of whom 99 failed on INSTIs-based STRs. Among these, 26 were treatment naïve with INSTI-based STR failure and 73 experienced virological failure after switching to INSTI-based STRs. Multivariable logistic regression analysis for the primary outcome revealed that PLHIV with INSTI-based STR failure were independently associated with previous exposure to first-generation INSTIs (adjusted OR 9.470, 95% CI: 3.880–23.115, p < 0.001), a non-MSM transmission route (adjusted OR 0.252, 95% CI: 0.098–0.649, p = 0.004) and current regimen> 12 months before genotypic resistance testing (adjusted OR 2.015, 95% CI: 1.067–3.805, p = 0.031). For the secondary outcomes, 24.4% (19/78) of tested PLHIV exhibited INSTI resistance at failure. Multivariable analysis showed that PLHIV failing EVG/COBI/TAF/FTC were significantly more likely to develop INSTI resistance (adjusted OR 22.75, 95% CI 2.114–244.868, p = 0.01) compared to BIC/TAF/FTC failures Conclusions: Virological failure on INSTI-based STRs in Taiwan is primarily driven by prior exposure to first-generation INSTIs. None of the treatment naïve patients with DTG or BIC-based STR failure developed INSTI resistance, but it is highly prevalent in patients failing first-generation INSTIs, such as EVG/COBI/TAF/FTC.
SN - 1876-0341
SN - 1876-035X
ER -