.webp&w=384&q=75){kind=logo}
Loading, please wait...
Loading, please wait...
Recent pharmacovigilance data highlight significant INSTI drug resistance signals for both first- and second-generation integrase inhibitors. An analysis of the WHO VigiBase database reveals disproportionate reporting for drugs like raltegravir and dolutegravir. This study underscores the need for clinical vigilance as these agents become cornerstones of antiretroviral therapy (ART) globally. Consequently, monitoring resistance patterns remains a vital part of HIV care.
Researchers conducted a comprehensive disproportionality analysis using VigiBase, which contains over 35 million individual case safety reports (ICSRs). The study identified 1,084 cases involving exposure to integrase strand-transfer inhibitors. Specifically, the data showed significant reporting odds ratios (ROR) for all five available INSTIs. This includes first-generation raltegravir and second-generation dolutegravir. Furthermore, most reports were classified as serious, highlighting the clinical impact of resistance.
The findings suggest that even second-generation drugs, which possess a high genetic barrier, are not immune to resistance. Most reported cases involved male patients from Europe and the Americas. However, these signals are critically relevant for clinicians in all regions. Therefore, medical professionals should prioritize resistance monitoring in clinical settings. Additionally, they should use this information to guide treatment switches and preserve the efficacy of the INSTI class.
Common mutations include N155H, Q148H/K/R, and Y143R. While second-generation inhibitors like dolutegravir are more robust, they can still fail if multiple mutations accumulate over time.
Monitoring is crucial because INSTIs are currently the preferred first-line treatment for HIV. Early detection of resistance prevents prolonged virological failure and reduces the risk of transmitting drug-resistant strains.
Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or a professional recommendation. Refer to the latest local and national guidelines for clinical practice.
References
Basílio HS et al. HIV resistance to integrase strand-transfer inhibitors: disproportionality analysis of individual case safety reports from the WHO global safety database (VigiBase). Curr Med Res Opin. 2026 Jun 11. doi: 10.1080/03007995.2026.2682588. PMID: 42275135.
World Health Organization (WHO). HIV drug resistance – brief report 2024. Available at: https://www.who.int/publications/i/item/9789240090330.
Stanford University. HIV Drug Resistance Database - INSTI Resistance Notes. Available at: https://hivdb.stanford.edu/dr-summary/resistance-notes/INSTI/.
Read summarized clinical updates, watch expert medical content, and earn CME certifications right from your smartphone.
Open your smartphone camera to scan and install.
A WHO VigiBase analysis reveals significant HIV drug resistance signals for all integrase strand-transfer inhibitors (INSTIs), including dolutegravir. This study highlights the need for continued clinical monitoring of resistance as INSTIs become standard care worldwide.
3 months ago
Explore the emerging role of Brixadi, an extended-release buprenorphine injection, for managing stimulant use disorder through kappa opioid receptor antagonism and steady plasma levels.
Today
A premature neonate developed upper limb compartment syndrome after uterine rupture extruded the arm through a scar defect. Conservative management with continuous monitoring yielded complete functional recovery and normal limb growth at 10-year follow-up, highlighting non-operative safety in selected cases.
Today
Dendritic cells bridge innate and adaptive immunity in myocardial infarction. This review explores their pathological roles, circulating dynamics, novel tolerogenic interventions, and how standard cardiovascular medications modulate dendritic cells to improve post-infarction myocardial repair and patient outcomes.
Today
Endoscopic posterior cervical fusion combines minimally invasive decompression, joint preparation, and rigid screw-rod fixation for atlantoaxial pathologies. Early clinical findings demonstrate solid bony union, excellent symptom relief, and minimal soft-tissue morbidity without significant vascular compromise.
Yesterday
Atherosclerosis involves extensive glycometabolic reprogramming across immune and vascular cells. This review examines how glycolysis, the pentose phosphate pathway, and lactate-driven epigenetic shifts fuel plaque vulnerability, while highlighting novel therapeutic targets like PFKFB3 and LDHA.
Today
