The Continuous Surveillance of InSTI Resistance Could be an Important Public Health Tool in the Fight Against HIV Infection

Aims: To evaluate the frequency of the InSTIs mutations in a large cohort of HIV-infected people. Background: The Highly Active Anti-Retroviral Therapy (HAART) allows turning HIV infection from a fatal disease to chronic infection, and Integrase Strand Transfer Inhibitors (InSTIs) represent the cornerstone of this treatment. However, the spread of HIV-1 drug resistance mutations represents an emerging threat to the long-term success of HIV treatment programs. Objectives: To evaluate the trend of the HIV drug resistance to InSTIs in a large cohort of HIVpositive people in order to assess the risk represented by these subjects in the spread of the HIV infection to the community. Methods: A cross-sectional study was conducted analysing all the InSTIs resistance tests performed in HIV positive subjects during 2017-2019 by the HIV Laboratory of the University Hospital "Gaetano Martino" of Messina, Italy. Results: In 2017-2019, 252 InSTIs resistance tests were performed, with 59 (23.4%), 88 (34.9%), and 105 (41.7%) tests respectively in the three considered years. Overall, 28 (11.1%) samples showed resistance to at least one of the four InSTIs. We observed a significant percentage increase of 95% in the resistance to all four drugs. Conclusion: InSTI resistance is not rare. Therefore, continuous surveillance along with incessant health education and a wide offer of the HIV test, can be the most important tools in the fight against HIV infection.