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Abstract

Transmitted integrase inhibitor resistance in newly diagnosed HIV remains rare. We report two cases with baseline resistance to all currently available integrase inhibitors in the Netherlands in 2025. Clinical history and laboratory findings indicate possible transmitted resistance. The cases are not phylogenetically linked, representing two independent introductions of integrase inhibitor resistant HIV into the Dutch population. These observations highlight the need for strengthened surveillance and prevention efforts in Europe and globally.

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/content/10.2807/1560-7917.ES.2026.31.8.2600108
2026-02-26
2026-03-15
/content/10.2807/1560-7917.ES.2026.31.8.2600108
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References

  1. Stanford University. HIV Drug Resistance Database, version 9.8. Palo Alto: Stanford University; 18 Feb 2026. Available from: https://hivdb.stanford.edu
  2. Bevers LAH, van Ewijk-Beneken Kolmer EWJ, Te Brake HML, Burger DM. Development, validation and clinical implementation of a UPLC-MS/MS bioanalytical method for simultaneous quantification of cabotegravir and rilpivirine E-isomer in human plasma. J Pharm Biomed Anal. 2024;238:115832.  https://doi.org/10.1016/j.jpba.2023.115832  PMID: 37976991 
  3. Bevers LAH, Toledo G, Kisekka M, Kaudha E, Ahimbisibwe GM, Deprez I, et al. Once-daily dolutegravir/lamivudine fixed-dose formulations in children living with HIV: a pharmacokinetic and safety sub-study nested in the open-label, multicentre, randomised, non-inferiority D3/PENTA 21 trial. EBioMedicine. 2025;120:105929.  https://doi.org/10.1016/j.ebiom.2025.105929  PMID: 41014973 
  4. Wensing AM, Calvez V, Ceccherini-Silberstein F, Charpentier C, Günthard HF, Jacobsen DM, et al. 2025 update of the drug resistance mutations in HIV-1. Top Antivir Med. 2025;33(2):457-73. PMID: 40472382 
  5. Castagna A, Maggiolo F, Penco G, Wright D, Mills A, Grossberg R, et al. Dolutegravir in antiretroviral-experienced patients with raltegravir- and/or elvitegravir-resistant HIV-1: 24-week results of the phase III VIKING-3 study. J Infect Dis. 2014;210(3):354-62.  https://doi.org/10.1093/infdis/jiu051  PMID: 24446523 
  6. Akil B, Blick G, Hagins DP, Ramgopal MN, Richmond GJ, Samuel RM, et al. Dolutegravir versus placebo in subjects harbouring HIV-1 with integrase inhibitor resistance associated substitutions: 48-week results from VIKING-4, a randomized study. Antivir Ther. 2015;20(3):343-8.  https://doi.org/10.3851/IMP2878  PMID: 25321146 
  7. van Sighem AI, Wit FWNM, Smit C, Jongen VW, Shalev N, Blomaard C. HIV Monitoring Report 2025. Human Immunodeficiency Virus (HIV) Infection in the Netherlands. Amsterdam: Stichting hiv monitoring; 20 Nov 2025. Available from: https://www.hiv-monitoring.nl/en/resources/monitoring-report-2025
  8. Pingen M, Nijhuis M, de Bruijn JA, Boucher CA, Wensing AM. Evolutionary pathways of transmitted drug-resistant HIV-1. J Antimicrob Chemother. 2011;66(7):1467-80.  https://doi.org/10.1093/jac/dkr157  PMID: 21502281 
  9. van Maarseveen NM, Wensing AM, de Jong D, Taconis M, Borleffs JC, Boucher CA, et al. Persistence of HIV-1 variants with multiple protease inhibitor (PI)-resistance mutations in the absence of PI therapy can be explained by compensatory fixation. J Infect Dis. 2007;195(3):399-409.  https://doi.org/10.1086/510533  PMID: 17205479 
  10. Li M, Oliveira Passos D, Shan Z, Smith SJ, Sun Q, Biswas A, et al. Mechanisms of HIV-1 integrase resistance to dolutegravir and potent inhibition of drug-resistant variants. Sci Adv. 2023;9(29):eadg5953.  https://doi.org/10.1126/sciadv.adg5953  PMID: 37478179 
  11. de Salazar A, Viñuela L, Fuentes A, Teyssou E, Charpentier C, Lambert-Niclot S, et al. Transmitted drug resistance to integrase-based first-line human immunodeficiency virus antiretroviral regimens in Mediterranean Europe. Clin Infect Dis. 2023;76(9):1628-35.  https://doi.org/10.1093/cid/ciac972  PMID: 36571282 
  12. World Health Organization (WHO). HIV drug resistance – brief report 2024. Geneva: WHO; 29 Feb 2024. Available from: https://www.who.int/publications/i/item/9789240086319
  13. Kantor R, Pau AK, Kozal MJ, Hyle EP. Do we need routine integrase resistance testing before starting antiretroviral therapy? Lancet HIV. 2025;12(9):e664-8.  https://doi.org/10.1016/S2352-3018(25)00108-0  PMID: 40541216 
  14. Loosli T, Han N, Hauser A, Josi J, Ingle SM, van Sighem A, et al. Predicted dolutegravir resistance in people living with HIV in South Africa during 2020-35: a modelling study. Lancet Glob Health. 2025;13(4):e698-706.  https://doi.org/10.1016/S2214-109X(24)00553-9  PMID: 40155107 
  15. van de Laar MJ, Bosman A, Pharris A, Andersson E, Assoumou L, Ay E, et al. Piloting a surveillance system for HIV drug resistance in the European Union. Euro Surveill. 2019;24(19):1800390.  https://doi.org/10.2807/1560-7917.ES.2019.24.19.1800390  PMID: 31088600 
  16. Yuan D, Zhao F, Liu Y, Liu S, Yan H, Liu L, et al. Deep sequencing reveals underestimated burden of integrase inhibitor resistance mutations in people living with HIV: a global individual patient data meta-analysis. Emerg Microbes Infect. 2025;14(1):2595793.  https://doi.org/10.1080/22221751.2025.2595793  PMID: 41293884 
  17. Price MN, Dehal PS, Arkin AP. FastTree 2--approximately maximum-likelihood trees for large alignments. PLoS One. 2010;5(3):e9490.  https://doi.org/10.1371/journal.pone.0009490  PMID: 20224823 
  18. Guindon S, Dufayard JF, Lefort V, Anisimova M, Hordijk W, Gascuel O. New algorithms and methods to estimate maximum-likelihood phylogenies: assessing the performance of PhyML 3.0. Syst Biol. 2010;59(3):307-21.  https://doi.org/10.1093/sysbio/syq010  PMID: 20525638 
  19. Gouy M, Tannier E, Comte N, Parsons DP. Seaview Version 5: a multiplatform software for multiple sequence alignment, molecular phylogenetic analyses, and tree reconciliation. Methods Mol Biol. 2021;2231:241-60.  https://doi.org/10.1007/978-1-0716-1036-7_15  PMID: 33289897 
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