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Overview of HIV drug resistance testing assays

Author
Michael J Kozal, MD
Section Editors
Martin S Hirsch, MD
Paul E Sax, MD
Deputy Editor
Jennifer Mitty, MD, MPH

INTRODUCTION

The use of drug resistance testing has become an integral part of HIV clinical care. The first clinical description of HIV resistance to an antiretroviral agent was published in 1989, when patients taking zidovudine monotherapy accumulated mutations within the reverse transcriptase gene, resulting in a marked increase in drug resistance [1]. Subsequently, HIV variants resistant to every available antiretroviral agent have been identified. The evolution of drug resistance has significant clinical implications for choosing effective antiretroviral regimens.

This topic will provide an overview of HIV drug resistance testing. The interpretation of these tests and the approach to selecting an antiretroviral therapy regimen for patients with drug resistance mutations are discussed elsewhere. (See "Interpretation of HIV drug resistance testing" and "Selecting an antiretroviral regimen for treatment-experienced HIV-infected patients who are failing therapy" and "Evaluation of the treatment-experienced patient failing HIV therapy".)

RATIONALE FOR HIV SUSCEPTIBILITY TESTING

The use of HIV susceptibility testing to guide therapy leads to better viral suppression and has been associated with improved survival [2,3]. As an example, in an observational study of more than 2699 HIV-infected patients who were eligible for genotypic and phenotypic testing between 1999 and 2005, resistance testing was associated with improved survival (adjusted hazard ratio, 0.69 [95% CI 0.51-0.94]) after controlling for demographics, CD4 cell count, HIV RNA level, and intensity of clinical follow-up [3].

GENOTYPIC VERSUS PHENOTYPIC ASSAYS

This section will provide an overview of the commonly used resistance assays. The use of resistance testing when selecting an antiretroviral regimen is discussed elsewhere. (See "Selecting antiretroviral regimens for the treatment-naïve HIV-infected patient", section on 'Considerations prior to initiating treatment' and "Evaluation of the treatment-experienced patient failing HIV therapy".)

Overview of the assays — Resistance assays can be categorized as either genotypic or phenotypic. These assays detect resistance in fundamentally different ways, although the results generally correlate with each other.

                       
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Literature review current through: Sep 2017. | This topic last updated: Sep 29, 2017.
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