HIV-2
NUCLEOSIDE AND NUCLEOTIDE REVERSE TRANSCRIPTASE INHIBITORS [1]
| Mutations associated with resistance | Mutations associated with « possible resistance » | |
| ZDV |  Q151M S215A/C/F/L/Y + 1 mutation among K65R, N69S/T, K70R, Y115F, K223R | S215A/C/F/L/Y |
| 3TC/FTC | M184I/V | K65R |
| ABC | K65R Q151M M184I/V + 1 mutation among: L74V, Y115F | 2 mutations among: D67N, K70N/R, M184V/I, S215A/C/F/L/Y |
| TDF/TAF | K65R Q151M + V111I |
ZDV: zidovudine, 3TC: lamivudine, FTC: emtricitabine, ABC: abacavir, TDF: tenofovir, TAF : tenofovir alafenamide
Didanosine and stavudine are not recommended.
PROTEASE INHIBITORS [1]
| Mutations associated with resistance | Mutations associated with « possible resistance » | |
| LPV | 2 mutations among: I82F, I84V, L90M I54M V47A | V62A + L99F 1 mutation among: I82F, I84V, L90M |
| DRV | I50V I54M I84V + L90M | 1 mutation among: I84V, L90M |
LPV: lopinavir, DRV : darunavir
For indinavir and saquinavir refer to previous rules (Version 27, September 2017).
Atazanavir and tipranavir are not recommended.
INTEGRASE STRAND TRANSFER INHIBITORS [1]
| Mutations associated with resistance | Mutations associated with « possible resistance » | |
| RAL | N155H/R Q148K/R/H [3,4,5] E92Q + T97A Y143C/G/R + 1 mutation among: E92Q, T97A Insertion at codon 231 [5] | E92Q Y143C/G/R |
| EVG | E92G/Q Q148K/R/H [3,4,5] N155H T97A + Y143C Insertion at codon 231 [5] | Y143C |
| DTG | Q148K G140S + Q148R/H [3,4,5] E92Q + N155H T97A + N155H Insertion at codon 231 [5] | Q148R/H [3] N155H E92Q T97A + Y143C |
| CAB* | Q148K G140S + Q148R/H [3,4,5] E92Q + N155H T97A + N155H Insertion at codon 231 [5] | Q148R/H [3] N155H E92Q T97A + Y143C |
| BIC* | Q148K G140S + Q148R/H [3,4,5] E92Q + N155H T97A + N155H | Q148R/H [3] N155H E92Q T97A + Y143C Insertion at codon 231 [5] |
RAL: raltegravir, EVG : elvitegravir, DTG: dolutegravir, CAB: cabotegravir, BIC: bictegravir
*Due to the very close structures of dolutegravir and cabotegravir, rules for dolutegravir are transposed to cabotegravir with the exception of the insertion at codon 231 for bictegravir.
NON-nuclEosidE REVERSE TRANSCRIPTASE INHIBITORS
| Naturally resistant to all NNRTI [2] |
FUSION INHIBITOR
| Naturally resistant to enfuvirtide [2] |
ATTACHMENT INHIBITOR
| Naturally resistant to fostemsavir [6] |
1/ Charpentier C et al. HIV-2EU-Supporting Standardized HIV-2 Drug-Resistance Interpretation in Europe: An Update. Clin Infect Dis. 2015 Jul 17. pii: civ572.
2/ Witvrouw E et al. Susceptibility of HIV-2, SIV and SHIV to various anti-HIV-1 compounds: implications for treatment and postexposure prophylaxis. Antivir Ther 2004; 9(1): 57-65.
3/ Smith RA et al. Three main mutational pathways in HIV-2 lead to high-level raltegravir and elvitegravir resistance: implications for emerging HIV-2 treatment regimens. PLoS ONE, 2012; 7.
4/ Smith RA, In vitro antiviral activity of cabotegravir against HIV-2. Antimicrob Agents Chemother. 2018 Jul 16. pii: AAC.01299-18. doi: 10.1128/AAC.01299-18.
5/ Le Hingrat Q et al. A 5 amino-acid insertion in the C-terminal region of HIV-2 integrase impacts phenotypic susceptibility to the five integrase inhibitors. 16th European Meeting on HIV & Hepatitis Treatment Strategies & Antiviral Drug Resistance, May 2018, Roma, Italy, Abstract 4.
6/ Lataillade M et al. Viral drug resistance through 48 weeks, in a phase 2b, randomized, controlled trial of the HIV-1 attachment
inhibitor prodrug, Fostemsavir. J Acquir Immune Defic Syndr. 2018 Mar 1;77(3):299-30