September 2012- Version n°22 ANRS - AC 11 : RESISTANCE GROUP GENOTYPE INTERPRETATION: NUCLEOSIDE AND NUCLEOTIDE REVERSE TRANSCRIPTASE INHIBITORS Mutations associated with resistance Mutations associated with " possible resistance "
T215Y/F
T215A/C/D/E/G/H/I/L/N/S/V [1, 2, 3, 4]
At least 3 mutations among : M41L, D67N, K70R, L210W, T215A/C/D/E/G/H/I/L/N/S/V, K219Q/E [1, 2, 3, 4]
Q151M
Insertion at codon 69 M184V/I K65R [11, 12, 16] Insertion at codon 69
Q151M
At least a score of + 2 among: M41L + T69D + 215Y/F + K219Q/E - K70R
K65R [11, 12] - M184 V/I [5, 14, 15, 17, 18]
L74V/I [19]
Q151M
Insertion at codon 69 V75A/M/S/T
T215A/C/D/E/G/H/I/L/N/S/V [4, 7]
T215Y/F [6]
At least 3 mutations among : M41L, D67N, K70R, L210W, T215A/C/D/E/G/H/I/L/N/S/V, K219Q/E [4, 7, 14, 15]
K65R [30, 31, 32]
Q151M
Insertion at codon 69 At least 4 mutations among : M41L, D67N, M184V/I, L210W, T215Y/F [8,
3 mutations among : M41L, D67N, M184V/I, L210W, T215Y/F [8, 19, 29] K65R [9, 11, 12]
L74V/I [24, 25, 26, 27, 28, 29]
Y115F
Q151M
Insertion at codon 69 At least 6 mutations among: M41L, E44D, D67N, T69D/N/S, L74V/I,
3, 4 or 5 mutations among: M41L, E44D, D67N, L210W, T215Y/F [13, 20, 33] T69D/N/S, L74V/I, L210W, T215Y/F [13, 33] K65R [9, 10, 11, 12]
Insertion at codon 69 K70E [21, 22, 23] ZDV: zidovudine, 3TC: lamivudine, FTC: emtricitabine, ddI: didanosine, d4T: stavudine, ABC: abacavir, TDF: tenofovir September 2012- Version n°22 ANRS - AC 11 : RESISTANCE GROUP GENOTYPE INTERPRETATION: NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS Mutations associated with resistance Mutations associated with " possible resistance "
L100I
K101E
K103H/N/S/T [1]
V106M [2]
E138K [12, 13]
Y181C/I
Y188C/L
G190A/C/E/Q/S/T/V
P225H
M230L A98S (for HIV-1 subtype C only) [3]
E138K [13]
L100I
K101E
K103H/N/S/T [1]
V106A/M [2]
Y181C/I
Y188C/H/L
G190A/C/E/Q/S/T/V
M230L At least 4 among: V90I, A98G, L100I,
3 mutations among: V90I, A98G, L100I, K101E/H/I/P/R, K101E/H/I/P/R, V106I, V179D/F/I/L/M/T, Y181C/I, V106I, V179D/F/I/L/M/T, Y181C/I, G190A/S,M230L [4, 7, 8, G190A/S,M230L [4, 7, 8, 9, 10, 11] 9, 10, 11] E138K [12, 13]
Y181V [5, 6]
E138A/G/Q/R [5, 6, 7, 8]
Y181C+H221Y [7]
K101E/P [9, 13]
E138A/G/K/Q/R/S [12, 13, 14]
V179L [9]
Y181C/I/V [13]
Y188L [9]
H221Y [13]
M230I/L/V [9]
L100I + K103N [9] EFV: efavirenz, NVP: nevirapine, ETR: etravirine, RPV : rilpivirine September 2012- Version n°22 ANRS - AC 11 : RESISTANCE GROUP GENOTYPE INTERPRETATION: PROTEASE INHIBITORS Mutations associated with resistance Mutations associated with " possible resistance "
M46I/L V82A/F/M/S/T [11]
I84A/V [8]
L90M and at least 2 among : K20M/R, L24I, V32I, M36I, I54V/L/M/T, A71V/T, G73S/A, V77I
At least 4 mutations among: L10F/I/M/R/V, I15A/V, K20I/M/R/T,
3 mutations among: L10F/I/M/R/V, I15A/V, K20I/M/R/T, L24I, 1000/100 mg L24I, I62V, G73S/T, V82A/F/S/T, I84V, L90M [9] I62V, G73S/T, V82A/F/S/T, I84V, L90M [9] V82A/F/S/T and at least 2 among: L10I, M36I, M46I/L, I84A/V [8] I54V/L/M/T, A71V/T, V77I [1]
L90M I50V
V32I and I47A/V [2, 13, 14] 700/100 mg BID At least 4 mutations among: L10F/I/V, L33F, M36I, I54A/L/M/S/T/V, I62V, V82A/C/F/G, I84V, L90M [2, 20]
At least 6 mutations among : L10F/I/R/V, K20M/R, L24I, L33F,
4 or 5 mutations among: L10F/I/R/V, K20M/R, L24I, L33F, M46I/L, I50V, F53L, I54M/L/T/V, L63P, A71I/L/V/T, V82A/F/S/T, M46I/L, I50V, F53L, I54M/L/T/V, L63P, A71I/L/V/T, I84V, L90M [3, 4, 5, 21] V82A/F/S/T, I84V, L90M [3, 4, 5, 21]
I47A [15, 16] L76V [18, 19]
I50L [6] 300/100 mg QD
N88S [28,29,30] At least 3 mutations among: L10F/I/V, G16E, L33F/I/V, M46I/L, D60E, I84V, I85V, L90M [7, 12, 22]
At least a score of + 3* : 36I/L/V - 53L/W/Y + 58E +
A score of + 2* : 36I/L/V - 53L/W/Y + 58E + 69I/K/N/Q/R/Y + 69I/K/N/Q/R/Y + 89I/M/R/T/V [10, 23] 89I/M/R/T/V [10, 23] 500/200 mg BID
At least 4 mutations among: V11I, V32I, L33F, I47V, I50V,
3 mutations among: V11I, V32I, L33F, I47V, I50V, I54L/M, I54L/M, T74P, L76V, I84V, L89V [17, 24, 25, 26] T74P, L76V, I84V, L89V [17, 24, 25, 26] 600/100 mg BID September 2012- Version n°22 IDV: indinavir, SQV: saquinavir, NFV: nelfinavir, RTV: ritonavir, FPV: fosamprenavir, LPV: lopinavir, ATV:atazanavir, TPV: tipranavir, DRV : darunavir * Insufficient data for HIV-1 subtype non-B September 2012- Version n°22 ANRS - AC 11 : RESISTANCE GROUP GENOTYPE INTERPRETATION: FUSION INHIBITOR Mutations associated with resistance G36A/D/E/S/V [1, 2, 3, 4, 5, 6, 7]
V38A/E/K/M
Q40H/K/P/T
N42D/T
N43D/H/K/S
L45Q/M ENF (T20): enfuvirtide September 2012- Version n°22 ANRS - AC 11 : RESISTANCE GROUP GENOTYPE INTERPRETATION: INTEGRASE INHIBITORS Mutations associated with resistance Mutations associated with " possible resistance "
T66K [10]
E92Q [1, 2]
G118R [10]
F121Y [10]
G140A/S [7]
Y143C/G/H/R/S [1, 3, 4, 5, 8] Q148E/G/H/K/R [1, 2]
V151L [9]
N155H/S/T [1, 2, 9]
E157Q [2] T66I/A/K [6]
E92Q [6]
F121Y [9]
E138K
G140C/S P145S [9]
S147G
Q148H/R/K [6]
V151L [9]
N155H/S/T [6,9]
E157Q [11] G118R [12,13]
T66K [9]
V151L [9]
S153F
S153Y
T66K + L74M
E92Q + N155H
E138A/K + Q148H/K/R
G140C/S + Q148H/K/R
Q148R + N155H RAL: raltegravir, EVG: elvitegravir, DTG: dolutegravir September 2012- Version n°22 ANRS - AC 11 : RESISTANCE GROUP GENOTYPE INTERPRETATION FOR HIV-2 NUCLEOSIDE AND NUCLEOTIDE REVERSE TRANSCRIPTASE INHIBITORS K65R : resistance to ddI, TDF, ABC [1]
Q151M : all NRTI except 3TC and FTC [1]
M184V : resistance to 3TC/FTC [1]
S215A/C/F/L/P/Y : resistance to AZT and d4T [1] NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS Naturally resistant to all NNRTI [2, 3]
PROTEASE INHIBITORS Naturally resistant to APV and fosAPV [2, 3] Contradictory data for ATV , TPV [2, 4]
FUSION INHIBITOR Naturally resistant to T20 [2, 3] INTEGRASE INHIBITORS Y143C/H/R : resistance to raltegravir [7]
Q148K/R : resistance to raltegravir [5]
N155H : resistance to raltegravir [6] September 2012- Version n°22 REFERENCES Nucleoside and Nucleotide Reverse Transcriptase Inhibitors
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Non nucleoside transcriptase inhibitors
1/ Harrigan PR, Mo T, Wynhoven B, Hirsch J, Brumme Z, McKenna P, Pattery T, Vingerhoets J, Bacheler LT. Rare mutations at codon 103 of HIV-1 reverse transcriptase can confer resistance to non-nucleoside reverse transcriptase inhibitors. AIDS. 2005 Mar 24;19(6):549-54.
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4/ Vingerhoets J et al. Impact of baseline NNRTI mutations on the virological response to TMC125 in the Phase III clinical trials DUET-1 and DUET-2. XVI International HIV drug resistance workshop : basic principles and clinical implications, 12-16 June 2007, Barbados, West Indies, abstract 32.
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5/ Marcelin AG et al. Factors associated with virological response to etravirine in nonnucleoside reverse transcriptase inhibitor-experienced HIV-1-infected patients. Antimicrob Agents Chemother. 2010 Jan;54(1):72-7.
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Protease inhibitors
1/ Phenotype/genotype correlation from Stanford database.
2/ Masquelier B, Assoumou KL, Descamps D, Bocket L, Cottalorda J, Ruffault A, Marcelin AG, Morand-Joubert L, Tamalet C, Charpentier C, Peytavin G, Antoun Z, Brun-Vézinet F, Costagliola D; ANRS Resistance Study Group. Clinically validated mutation scores for HIV-1 resistance to fosamprenavir/ritonavir. J Antimicrob Chemother. 2008 Jun;61(6):1362-8.
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and pharmacological parameters predicting the response to lopinavir-ritonavir in heavily protease inhibitor-experienced patients. Antimicrob Agents Chemother. 2005 May;49(5):1720-6.
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17/ de Meyer S, Vangeneugden T, van Baelen B, de Paepe E, van Marck H, Picchio G, Lefebvre E, de Béthune MP. Resistance profile of darunavir: combined 24-week results from the POWER trials. AIDS Res Hum Retroviruses. 2008 Mar;24(3):379-88.
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23/ Bethell R et al. No effect of subtype on susceptibility and virological response to TPV/r for treatment experienced patients. XVII International HIV drug resistance workshop : basic principles and clinical implications, 10-14 June 2008, Sitges, Spain, abstract 111.
24/ Descamps D et al. Mutations associated with virological response to darunavir/ritonavir in HIV-1-infected protease inhibitor-experienced patients. J Antimicrob Chemother. 2009 Mar;63(3):585-92.
25/ De Meyer S. et al. Influence of baseline protease inhibitor resistance on the efficacy of darunavir/ritonavir or lopinavir/ritonavir in the TITAN trial. J Acquir Immune Defic Syndr. 2008 Dec 15;49(5):563-4.
26/ De Meyer S. et al. Phenotypic and genotypic determinants of resistance to darunavir: analysis of data from treatment-experienced patients in POWER 1, 2, 3 and DUET-1 and 2. XVII International HIV drug resistance workshop : basic principles and clinical implications, 10-14 June 2008, Sitges, Spain, abstract 31.
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