HIV Resistance

Question 1

HIV mutation master chart

Answer 1

HIV - Stanford Database

A. TAMs - M41L & D67N (AZT)
B. Non-TAMs - M184VI (3TC & FTC but BOOSTS TFV) & K65R (TFV & ABV)
C. MDR - Q151M (Pan NRTI) & T69 deletions

C. NNRTI - L100I & K101P (All except DOR)

D. INSTI - G118R

E. PI - D30N & V32I

Question 2

TROFILE assays

Answer 2

Phenotypic
Minimum VL 1000 copies/mL

Generates replication defective virus from patient derived envelope protein that are then used to infect target cell line that express either CCR5 or CXCR4

CXCR4 strains predominate at later stage of HIV infection and prefer naive T cells.

Question 3

1st line treatment failure Wild type percent

Answer 3

70%!!

Question 4

K65R

Answer 4

HIV B & C increased K65R

TDF, ABV, LAM containing regimen increased K65R

Increases AZT susceptibility

Question 5

M184V + K65R

Answer 5

Increased AZT susceptibility (in vitro)

BUT real world data: NADIA trial - TDF/3TC reduced risk of VF vs AZT/3TC @ 96 weeks

Question 6

TAMS

Answer 6

Type 1

M41L
L210W
T215Y

Type 2

D67N
K70R
T215F
K219Q/E

Question 7

TAMS + M184V

Answer 7

Most TAMS occur with M184V

Decreases impact of TAMS on TFV & AZT

Increases impact on ABV

Question 8

K103N

Answer 8

NNRTI mutation

Most commonly transmitted mutation

Reduced to NVP & EFV

Does not reduce susceptibility to RPV or DOR

Question 9

1st like treatment failure on NNRTI

Answer 9

1 DOL + 2 NRTIs

2. Boosted PI + 2 NRTIs
3. Boosted PI + INSTI

Question 10

RAL resistance

Answer 10

Q148HRK most common with failure + G140 - 100 fold reduction

N155H
Y143CR

Question 11

DOL resistance

Answer 11

R263K
N155H
Q148HRK (same as RAL)

Question 12

1st line Tx failure in INSTI Resistance

Answer 12

1. Switch to PI
2. Switch RAL to DTG (DOUBLE DOSE!!)
3. Switch to NNRTI/maraviroc

Question 13

DARUNAVIR resistance

Answer 13

I47N
I50V

Question 14

1st line Tx failure for PI

Answer 14

1 No change (if no resistance and repeat VL in 4 weeks)

2 switch PI

3. Switch to INSTI