Drug resistance mutations for surveillance of transmitted HIV-1 drug-resistance: 2009 update.

Drug resistance mutations for surveillance of transmitted HIV-1 drug-resistance: 2009 update.

Programs that monitor local, national, and regional levels of transmitted HIV-1 drug resistance inform treatment guidelines and provide feedback on the success of HIV-1 treatment and prevention programs. To accurately compare transmitted drug resistance rates across geographic regions and times, the World Health Organization has recommended the adoption of a consensus genotypic definition of transmitted HIV-1 drug resistance. In January 2007, Bennet and colleagues outlined criteria for developing a list of mutations for drug-resistance surveillance and compiled a list of 80 reverse transcriptor and protease mutations meeting these criteria (surveillance drug resistance mutations). Since January 2007, several new drugs have been approved and several new drug-resistance mutations have been identified. In this paper, the authors follow the same procedures described previously to develop an updated list of surveillance drug resistance mutations that are likely to be useful for ongoing and future studies of transmitted drug resistance. The updated surveillance drug resistance mutation list has 93 mutations including 34 non-nucleoside reverse transcriptase protease inhibitor-resistance mutations at 15 reverse transcriptor positions, 19 non-nucleoside reverse transcriptase protease inhibitor-resistance mutations at 10 reverse transcriptor positions, and 40 protease inhibitor-resistance mutations at 18 protease positions.

Editors’ note: Population-based surveillance of transmitted drug resistance in recently infected individuals is a cornerstone of optimal treatment programmes. This WHO updated list of surveillance drug mutations is not designed to be used for individual patient management. Rather, its value lies in the fact that it permits accurate estimation of transmitted resistance as well as comparison of estimates of transmitted resistance from different regions and times.