[Detection of resistance mutations in proviral DNA in HIV-1 infection]

Analysis of proviral DNA in HIV infection may have useful applications if techniques that are sufficiently sensitive to detect minor variants, such as single genome sequencing (SGS), are used. This technology, which is performed in DNA from whole blood, improves determination of co-receptor tropism and the detection of both circulating and archived resistance mutations (RM) that are undetectable in plasma. Many of these RM have clinical relevance and their identification could be useful in specific situations, such as the start of antiretroviral therapy to exclude the transmission of resistant strains, as information to be weighed in simplification strategies in patients with undetectable viral loads, and in antiretroviral-experienced patients with limited availability of clinical reports. Clonal analysis using SGS has yielded useful information on the pathogenesis and diagnosis of HIV-1 infection but, in its current design, is inappropriate for the clinical laboratory. The new generation of sequencing technology, which allows the simultaneous analysis of a large number of sequences, has begun to be applied in the analysis of the diversity of plasma HIV-1. The use of these highly sensitive, automated techniques in the analysis of HIV-1 cellular reservoirs will potentially allow all variants recorded during the history of the disease to become available. This information would be highly useful for the clinical management of HIV-1 infection at the individual and population level.