UPDATE ON DRUG RESISTANCE MUTATIONS IN HIV-1

TLDR

The Resistance Mutations Project panel has updated recommendations for interpreting HIV‑1 drug resistance tests, noting that the evolutionary sequence and contribution of mutations—particularly secondary mutations at codons 10, 20, 24, 46, 53, 54, 71, 82, 84, and 90—remain debated. Key updates include eliminating the primary/secondary distinction for reverse transcriptase mutations, retaining it for protease mutations linked to resistance magnitude, adding tenofovir (K65R) and lopinavir resistance mutations, and introducing a multi‑protease inhibitor resistance category with primary mutations at codons 46, 82, 84, and 90. Additional information is available at http://www.iasusa.org.

Abstract

UPDATE ON DRUG RESISTANCE MUTATIONS IN HIV-1 [D’Aquila RT, et al.Topics in HIV Med2001;9:31]: The “Resistance Mutations Project panel” has provided updated recommendations for interpreting resistance tests. Major changes are summarized below: There is no longer a distinction between primary and secondary resistance mutations in the reverse transcriptase gene. The rationale is based on the observation that the sequence of evolution and the contribution to total resistance is debated for these mutations. However, the distinction between primary and secondary mutations will be retained for the protease gene because these correlate with the magnitude of resistance. The nucleotide RT inhibitor, tenofovir, has been added. The resistance gene is K65R. Mutations that confer resistance to lopinavir have been added. These are all secondary mutations and include those at codons 10, 20, 24, 46, 53, 54, 71, 82, 84, and 90. There is now the addition of the “multi-protease inhibitor resistance,” in which the primary mutations are at codons 46, 82, 84, and 90. Additional information is available from http://www.iasusa.org.