With the current widespread use of dolutegravir in low-income countries, the understanding of the impact of nucleoside reverse transcriptase inhibitor (NRTI-) associated mutations on the efficacy of dolutegravir-containing antiretroviral therapy (ART) is of utmost importance. We describe a rare case of a patient with pre-existing M184V/I mutation and virological failure on a dolutegravir/lamivudine/abacavir regimen with the emergence of integrase strand transfer inhibitor resistance mutations. Additional risk factors, which may have triggered the virological failure, included suboptimal adherence and low nadir CD4+ cell count. This case illustrates that dolutegravir-containing triple-therapy should be prescribed with caution to patients with pre-existing M184V/I mutation and poor efficacy of the reverse transcriptase inhibitor backbone. In addition, this case highlights the need for viral load monitoring in patients on dolutegravir-containing regimens in settings with a high prevalence of the M184V/I mutation such as in low-income countries.

中文翻译：

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在接受过M184V / I突变治疗的有治疗经验的患者中，在含有Dolutegravir的三联疗法期间，对整合链转移抑制剂的耐药性出现

随着低收入国家/地区目前普遍使用dolutegravir，了解核苷逆转录酶抑制剂（NRTI-）相关突变对含dolutegravir的抗逆转录病毒疗法（ART）的功效的影响至关重要。我们描述了一个罕见的病例，该患者患有既往存在的M184V / I突变，并在dolutegravir / lamivudine / abacavir方案上发生病毒学失败，并出现了整合酶链转移抑制剂耐药性突变。其他可能引发病毒学失败的危险因素包括依从性欠佳和最低的CD4 +细胞计数。该病例说明，对于患有既往M184V / I突变且逆转录酶抑制剂骨架疗效较差的患者，应谨慎使用含dolutegravir的三联疗法。