Understanding integrase inhibitor resistance in Angola: a comparative analysis of INSTI-naive and INSTI-experienced individuals.
6 affiliations
- 1Instituto Nacional de Luta Contra SIDA (INLS), Ministério da Saúde, Luanda, Angola.
- 2Global Health and Tropical Medicine, GHTM, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, Lisboa, Portugal.
- 3Tufts University School of Medicine, Boston, MA, USA.
- 4Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz, Rio de Janeiro 21045-900, Brazil.
- 5Instituto Adolfo Lutz, Centro de Virologia, São Paulo, SP, Brazil.
- 6Amsterdam Institute for Global Health and Development, and Department of Global Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Abstract
Background
Africa 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
A 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
Of 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
In 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.
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BibTeX
@article{pocongo2026understanding,
title = {{Understanding integrase inhibitor resistance in Angola: a comparative analysis of INSTI-naive and INSTI-experienced individuals.}},
author = {Bárbara Pocongo and Maria Furtado and Cláudia Bernardi and Lucrécia Jacinto and Aulória José and Jaime Urica and Rosa Torres and Francisco Vunge and Beatriz Almeida and Michael R Jordan and Carlos Jesus and Monick Lindenmeyer Guimarães and Cíntia Mayumi Ahagon and Giselle Lopes and Luís Brígido and Seth Inzaule and Ana B Abecasis and Ricardo Parreira and João Piedade and Victor Pimentel},
journal = {The Journal of antimicrobial chemotherapy},
year = {2026},
month = nov,
doi = {10.1093/jac/dkag355},
url = {https://europepmc.org/article/MED/42975147},
note = {CC BY},
}
RIS
TY - JOUR
TI - Understanding integrase inhibitor resistance in Angola: a comparative analysis of INSTI-naive and INSTI-experienced individuals.
AU - Bárbara Pocongo
AU - Maria Furtado
AU - Cláudia Bernardi
AU - Lucrécia Jacinto
AU - Aulória José
AU - Jaime Urica
AU - Rosa Torres
AU - Francisco Vunge
AU - Beatriz Almeida
AU - Michael R Jordan
AU - Carlos Jesus
AU - Monick Lindenmeyer Guimarães
AU - Cíntia Mayumi Ahagon
AU - Giselle Lopes
AU - Luís Brígido
AU - Seth Inzaule
AU - Ana B Abecasis
AU - Ricardo Parreira
AU - João Piedade
AU - Victor Pimentel
PY - 2026
DA - 2026/11/01
JO - The Journal of antimicrobial chemotherapy
DO - 10.1093/jac/dkag355
UR - https://europepmc.org/article/MED/42975147
AB - Background Africa 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 A 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 Of 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 In 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.
SN - 0305-7453
SN - 1460-2091
ER -