HIV-1 Drug Resistance Mutations: Potential Applications for Point-of-Care Genotypic Resistance Testing

PLoS One. 2015 Dec 30;10(12):e0145772. doi: 10.1371/journal.pone.0145772. eCollection 2015.

Abstract

The increasing prevalence of acquired and transmitted HIV-1 drug resistance is an obstacle to successful antiretroviral therapy (ART) in the low- and middle-income countries (LMICs) hardest hit by the HIV-1 pandemic. Genotypic drug resistance testing could facilitate the choice of initial ART in areas with rising transmitted drug resistance (TDR) and enable care-providers to determine which individuals with virological failure (VF) on a first- or second-line ART regimen require a change in treatment. An inexpensive near point-of-care (POC) genotypic resistance test would be useful in settings where the resources, capacity, and infrastructure to perform standard genotypic drug resistance testing are limited. Such a test would be particularly useful in conjunction with the POC HIV-1 viral load tests that are currently being introduced in LMICs. A POC genotypic resistance test is likely to involve the use of allele-specific point mutation assays for detecting drug-resistance mutations (DRMs). This study proposes that two major nucleoside reverse transcriptase inhibitor (NRTI)-associated DRMs (M184V and K65R) and four major NNRTI-associated DRMs (K103N, Y181C, G190A, and V106M) would be the most useful for POC genotypic resistance testing in LMIC settings. One or more of these six DRMs was present in 61.2% of analyzed virus sequences from ART-naïve individuals with intermediate or high-level TDR and 98.8% of analyzed virus sequences from individuals on a first-line NRTI/NNRTI-containing regimen with intermediate or high-level acquired drug resistance. The detection of one or more of these DRMs in an ART-naïve individual or in a individual with VF on a first-line NRTI/NNRTI-containing regimen may be considered an indication for a protease inhibitor (PI)-containing regimen or closer virological monitoring based on cost-effectiveness or country policy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Atazanavir Sulfate / pharmacology
  • Atazanavir Sulfate / therapeutic use
  • Darunavir / pharmacology
  • Darunavir / therapeutic use
  • Drug Resistance, Viral / genetics*
  • Drug Therapy, Combination
  • Genotyping Techniques / methods*
  • HIV Infections / drug therapy
  • HIV-1 / drug effects
  • HIV-1 / genetics*
  • Humans
  • Lopinavir / pharmacology
  • Lopinavir / therapeutic use
  • Mutation / genetics*
  • Point-of-Care Systems*
  • Protease Inhibitors / pharmacology
  • Protease Inhibitors / therapeutic use
  • Reverse Transcriptase Inhibitors / pharmacology
  • Reverse Transcriptase Inhibitors / therapeutic use
  • Ritonavir / pharmacology
  • Ritonavir / therapeutic use
  • Treatment Failure

Substances

  • Protease Inhibitors
  • Reverse Transcriptase Inhibitors
  • Lopinavir
  • Atazanavir Sulfate
  • Ritonavir
  • Darunavir