Emergence of Integrase Strand Transfer Inhibitors Resistance Mutations in Multidrug-Resistant Human Immunodeficiency Virus Strains Detected in Integrase Strand Transfer Inhibitors Naïve Indian Persons Living with Human Immunodeficiency Virus: A Repor

Integrase strand transfer inhibitors (INSTIs) represent a recent class of antiretroviral therapy agents, with dolutegravir widely adopted due to its effectiveness and favorable safety profile. Despite their increasing use, drug resistance mutations (DRMs) affecting INSTIs remain rare. This report describes three cases of INSTI-naïve Indian persons living with human immunodeficiency virus who exhibited DRMs conferring resistance to INSTIs. The detected DRMs include E92Q in the first patient, Q148QH and V151VL in the second patient, and S153F in the third patient, conferring varying levels of resistance to INSTI agents. This report presents the first cases from India with major nonpolymorphic INSTI DRMs, indicating that resistance to INSTIs is an emerging threat that needs to be addressed through routine surveillance.