Fast Five Quiz: Treatment-Resistant HIV

Michael Stuart Bronze, MD


May 10, 2021

A two-drug regimen is now included in the recommended initial treatment choices from the DHHS Panel and includes the integrase inhibitor dolutegravir in combination with the nucleoside reverse transcriptase inhibitor (NRTI) lamivudine. However, this combination is not recommended for individuals with pretreatment HIV RNA levels > 500,000 copies/mL, those with known hepatitis B virus (HBV) coinfection, or for those who will begin treatment before receiving the results of HIV resistance testing/HBV testing.

NNRTIs are more prone to drug resistance, whereas second-generation HIV integrase inhibitors (dolutegravir and bictegravir) and newer-generation protease inhibitors (darunavir) have a high barrier to resistance.

The Joint United Nations Programme on HIV/AIDS has identified key population groups that are particularly vulnerable to HIV and often lack access to healthcare services. These include gay men and other men who have sex with men, sex workers, transgender people, people who inject drugs, and prisoners and other incarcerated people. A recent systematic review found that pretreatment drug resistance exceeds 10% in several of these populations. In addition, the WHO states that up to 26% of people initiating HIV treatment are infected with a virus carrying resistance to first-line drugs.

Learn more about first- and later-line HIV treatment options.


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