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HIV resistance testing

Indications: - HIV1 infection - all HIV1 patients who enter care - even if immediate treatment is not planned [2] - HIV1 treatment failure [1,5] Procedure: 1) genotype testing a) identifies mutations present in HIV genes 1] reverse transcriptase 2] retroviral protease 3] integrase b) identifies about 80% of resistant forms of HIV1 c) results available in about 1-2 weeks d) generally 1st test: faster & cheaper than phenotype testing [1] 2) phenotype testing a) measures ability of HIV to multiply in the presence of varying concentrations of drugs b) involves recombination of genetic material in specimen obtained from patient with HIV laboratory clone c) results available in 2-3 weeks Laboratory: - see ARUP consult [4] - HIV phenotype may linke to Loincs of interest Notes: - may not be reliable if patient is not on antiretroviral therapy because resistance may not manifest without selective pressure of antiretroviral agents [1] - Sentosa SQ HIV Genotyping Assay is the first FDA-authorized test for HIV mutations that uses next-generation sequencing [6] - > 95% sensitive & specific for detecting 342 HIV drug resistant mutations [6]

Related

HIV phenotype [Susceptibility] HIV-1 coreceptor tropism (Trofile) human immunodeficiency virus-1 (HIV-1)

Specific

HIV integrase inhibitor mutation HIV nonnucleoside reverse transcriptase gene mutation HIV nucleoside reverse transcriptase gene mutation HIV protease gene mutation

General

HIV1 nucleic acid antibiotic sensitivity (Kirby-Bauer susceptibility testing)

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 18. American College of Physicians, Philadelphia 2009, 2012, 2018
  2. Aberg JA et al Primary care guidelines for the management of persons infected with human immunodeficiency virus: 2009 update by the HIV medicine Association of the Infectious Diseases Society of America. PMID: 19640227
  3. Genotypic Resistance Testing Lab Tests Online: genotypic
  4. ARUP Consult: Human Immunodeficiency Virus 1, Antiretroviral Drug Resistance Testing - HIV Drug Resistance The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/human-immunodeficiency-virus-1-antiretroviral-drug-resistance-testing
  5. Taylor S, Jayasuriya A, Smit E. Using HIV resistance tests in clinical practice. J Antimicrob Chemother. 2009 Aug;64(2):218-22. PMID: 19535382
  6. FDA News Release. Nov 5, 2019 FDA authorizes marketing of first next-generation sequencing test for detecting HIV-1 drug resistance mutations. https://www.fda.gov/news-events/press-announcements/fda-authorizes-marketing-first-next-generation-sequencing-test-detecting-hiv-1-drug-resistance
  7. HIV RESISTANCE TESTING AIDS.org http://www.aids.org/factsheets/126-HIV-Resistance-Testing.html