Antiretroviral resistance in HIV
From IDWiki
- Genotyping sequences reverse transcriptase, integrase, and protease
- Resistance point mutations names as wild-type amino acid, position, and mutant amino acid (e.g. K 103 N)
- Bulk sequencing can only detect mutations that represent >20% of HIV
Common Mutations
- NRTIs
- M184V/I confers resistance to lamivudine, emtricitabine, and abacavir, but increases susceptibility to tenofovir, so combinations that include tenofovir are still safe to use
- K65R confers resistance to lamivudine, emtricitabine, and abacavir
- TAMS (M41L, D76N, K70R, L210W, T215Y, K219Q) confer resistance to basically all NRTIs as they increase in number
- Q151M, 69SSS confers resistance to NRTIs
- NNRTIs
- K103N confers resistance to efavirenz and nevirapine
- Y181C confers resistance to nevirapine and other NNRTIs
- E138K and K101E confer resistance to rilpivirine and other NNRTIs
- I50L confers resistance to atazanavir
- INSTIs
- N155H and Q148H/R?K confer resistance to raltegravir and elvitegravir
- Y143C confers resistance to raltegravir
- R263K confers resistance to dolutegravir
All Mutations
| Drug | Mutation | Notes |
|---|---|---|
| NRTIs | ||
| 69 insertion complex | M41L | multi-NRTI resistance |
| A62V | ||
| * 69 insert | ||
| K70R | ||
| L210W | ||
| T215YF | ||
| K219QE | ||
| 151 complex | A62V | multi-NRTI resistance |
| V75I | ||
| F77L | ||
| F116Y | ||
| Q151M | ||
| Thymidine analogue-associated mutations (TAMs) | M41L | resistance to AZT and d4T; resistance to others is proportional to the number of TAMs, and with 4 or more mutations there is resistance to essentially all NRTIs |
| D67N | ||
| K70R | ||
| L210W | ||
| T215Y/F | ||
| K219Q/W | ||
| Abacavir | K65R/E/N | common |
| L74V | ||
| Y115F | ||
| M184V | common; can still use TDF, AZT | |
| Emtricitabine | K65R/E/N | common |
| M184V/I | common; can use ABC (if M184I), TDF, AZT; can still use FTC in combination with TDF or TAF | |
| Lamivudine | K65R/E/N | common |
| M184V/I | common; can use ABC (if M184I), TDF, AZT; can still use 3TC in combination with TDF or TAF | |
| Tenofovir | K65R/E/N | common |
| K70E | ||
| Zidovudine | M41L | |
| D67N | ||
| K70R | ||
| L210W | ||
| T215Y/F | ||
| K219Q/E | ||
| NNRTIs | ||
| Doravirine | V106A/I/M/T | |
| Y188C/L/H | ||
| G190E | ||
| P225H | ||
| F227C/L/R | ||
| M230L | ||
| L234I | ||
| Efavirenz | L100I | |
| K101P | ||
| K103N/S | ||
| V106M | ||
| V108I | ||
| Y181C/I | ||
| Y188L | ||
| G190S/A | ||
| P225H | ||
| M230L | ||
| Nevirapine | L100I | |
| K101P | ||
| K103N/S | ||
| V106A/M | ||
| V108I | ||
| Y181C/I | common | |
| Y188C/L/H | ||
| G190A | ||
| M230L | ||
| Rilpivirine | L100I | |
| K101E/P | common | |
| E138A/G/K/Q/R | common | |
| V179L | ||
| Y181C/I/V | common | |
| Y188L | ||
| H221Y | ||
| F227C | ||
| M230I/L | ||
| Protease inhibitors | ||
| Atazanavir | L10I/F/V/C | |
| G16E | ||
| K20R/M/I/T/V | ||
| L24I | ||
| V32I | ||
| L33I/F/V | ||
| E34Q | ||
| M36I/L/V | ||
| M46I/L | ||
| G48V | ||
| I50L | common | |
| F53L/Y | ||
| I54L/V/M/T/A | ||
| D60E | ||
| I62V | ||
| I64L/M/V | ||
| A71V/I/T/L | ||
| G73C/S/T/A | ||
| V82A/T/F/I | ||
| I84V | ||
| I85V | ||
| N88S | ||
| L90M | ||
| I93L/M | ||
| Darunavir | V11I | |
| V32I | ||
| L33F | ||
| I47V | ||
| I50V | ||
| I54M/L | ||
| T74P | ||
| L76V | ||
| I84V | ||
| L89V | ||
| INSTIs | ||
| Bictegravir | G118R | |
| E138K | ||
| G140S | ||
| Q148H | ||
| R263K | ||
| Cabotegravir | T66K | |
| G118R | ||
| E138A/K/T | ||
| G140A/C/R/S | ||
| Q148H/K/R | ||
| S153F/Y | ||
| N155H | ||
| R263K | ||
| Dolutegravir | G118R | |
| F121Y | ||
| E138A/K/T | ||
| G140A/S | ||
| Q148H/K/R | ||
| N155H | ||
| R263K | common | |
| Elvitegravir | T66I/A/K | |
| E92Q/G | ||
| T97A | ||
| F121Y | ||
| S147G | ||
| Q148H/K/R | common | |
| N155H | common | |
| R263K | ||
| Raltegravir | L74M | |
| E92Q | ||
| T97A | ||
| F121Y | ||
| E138A/K | ||
| G140A/S | ||
| Y143R/H/C | common | |
| Q148H/K/R | common | |
| N155H | common | |
| R263K | ||
