Do HIV minority variants matter clinically?


541 HIV-positive treatment naïve patients started treatment with a rilpivirine containing regimen. Next generation sequencing (NGS) was performed to identify minority resistant variants to nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs). 489 of the 541 samples were successfully amplified and analysed with NGS. Using two different algorithms with a 1 % threshold, rilpivirine resistance associated mutations (RAMS) were found in 8.8 and 7.4 % of the patients. Detection of minority rilpivirine resistance varieties had no impact on the virological response after 12 months of therapy.

Raymond et al. Clin Infect Dis 2018;66:1588-1594

Comment: These results indicate that the usefulness of searching for resistance in minor viral populations by next generation sequencing is limited in routine clinical practice.