HIV resistance Dr. Laura Waters Welcome to your HIV resistance Dr. Laura Waters Which of the following regarding HIV resistance is/are FALSE? a. HIV has a long half-life and high replication rate b. Reverse transcriptase is very error prone when replicating c. Most mutations are beneficial to the HIV virus d. Acquired resistance occurs in individuals who have never been exposed to ART e. Archived resistance can emerge under drug pressure years later Which of the following regarding the genetic barrier to resistance is/are TRUE? a. Drugs with a low genetic barrier to resistance do not require support of any fully active drugs b. Boosted protease inhibitors have a high genetic barrier to resistance c. If a patient develops cross-resistance, switching from low barrier drugs should be delayed d. First generation NNRTIs and rilpivirine have a low genetic barrier to resistance e. All mutations, or combinations of mutations have the same effect Which of the following regarding resistance testing is/are FALSE? a. BHIVA recommend testing treatment - experienced patients if they have a viral load - 200 cell/mm3, persistent low level viraemia or repeated blips in viral load b. Routine resistance tests (population sequencing) may miss 'minority' resistant strains c. Resistance at HIV-RNA levels 500-1000 copies/mL is likely to be missed when testing d. Use of ultra-sensitive resistance testing is widely available e. BHIVA recommend routine integrase resistance testing in the presence of any transmitted drug resistance Which of the following is/are FALSE regarding integrase resistance? a. Dolutegravie 50mg twice daily should be used if a patient has integrase strand transfer inhibitor resistance-associated mutations (INSTI RAMS) b. A patient experiencing early failure on raltegravir or elvitegravir is unlikely to still be susceptible to dolutegravir c. Extensive cross-resistance occurs between raltegravir and elvitegravir through mutations at positions 155 and 148 d. Raltegravir is recommended for use as single drug intensification e. Integrase is not susceptible to cross-resistance Which of the following is/are TRUE regarding NNRTI and NRTI mutations? a. The M184V mutation diminishes viral fitness by ^75% b. Doravirine has a lower barrier to resistance than efavirenz and rilpivirine c. K103N is the most frequent mutation conferring resistance to efavirenz d. The M184V mutation confers high level resistance to lamivudine and emtricitabine e. There are unlikely to be other mutations present in the presence of thymidine analogue mutations (TAMs) Time is Up!