In phase 3 clinical trials, long-acting injectable cabotegravir (CAB-LA), an integrase strand-transfer inhibitor (INSTI) and analogue of DTG, was shown to be highly efficacious at reducing risk of HIV infection when used for HIV preexposure prophylaxis (PrEP) compared with the oral-PrEP regimen tenofovir-emtricitabine (TDF/FTC)[3, 4]. With approval of the US Food and Drug Administration and anticipated approval in other countries, concerns for emergence of drug-resistant HIV because of rollout of CAB-LA for PrEP, which may negatively impact outcomes of DTG-based treatment, have been raised. We sought to characterize the prevalence and patterns of mutations associated with DTG resistance in persons diagnosed with HIV after receiving CABLA PrEP.

We conducted a systematic review of available English language literature on PubMed, according to the following search strategy:‘HIV’and (resistance) and (’GSK1265744’or ‘Cabotegravir’). We also searched peer-reviewed abstracts from major HIV conferences between 2019 and 2022. Searches were conducted in March 2022. Bibliographies of relevant articles were screened for additional references. The main analysis included studies reporting resistance emerging from CAB-LA PrEP and excluded pharmacokinetic/pharmacodynamic studies and preclinical trials.