Practical updates in clinical antiviral resistance testing

Area of Science:

• Clinical Virology
• Molecular Diagnostics
• Infectious Diseases

Background:

• Antiviral resistance testing is crucial for managing viral infections.
• The field is dynamic due to new drugs, evolving viruses, and technological advancements.
• Clinical laboratories face financial and logistical pressures impacting testing strategies.

Purpose of the Study:

• To review the current landscape of antiviral resistance testing in the United States in 2024.
• To cover common viruses including herpes simplex virus, cytomegalovirus, human immunodeficiency virus, influenza, hepatitis B, and hepatitis C.
• To discuss test methods, resistance mechanisms, and clinical indications.

Main Methods:

• Mini-review of clinically available antiviral resistance testing methods.
• Focus on genotypic and phenotypic testing approaches.
• Examination of next-generation sequencing technologies.

Main Results:

• A shift from phenotypic to genotypic methods for initial clinical testing is evident.
• Next-generation sequencing is becoming more prevalent in clinical laboratories.
• Uncertainty exists regarding the clinical significance of detecting minority variants.

Conclusions:

• Genotypic testing is increasingly the standard for antiviral resistance detection.
• The interpretation of minority variants requires further clinical validation.
• Adapting to technological and drug changes is essential for effective viral disease management.