Do we need routine integrase resistance testing before starting antiretroviral therapy?

Area of Science:

• Infectious Diseases
• Virology
• Pharmacology

Background:

• Oral second-generation integrase strand transfer inhibitors (INSTIs) are cornerstone antiretroviral therapy (ART) globally due to high resistance barriers.
• Current guidelines in high-income countries recommend routine protease and reverse transcriptase resistance testing, but integrase resistance testing is reserved for high-risk individuals.
• Uncertainty exists regarding the optimal strategy for integrase resistance testing before ART initiation.

Purpose of the Study:

• To highlight the importance of characterizing transmitted integrase resistance.
• To inform future clinical decision-making and guideline development for INSTI-based ART.
• To address the challenge of balancing drug class protection with resource allocation and care complexity.

Main Methods:

• This abstract discusses the current landscape of resistance testing in ART.
• It emphasizes the need for improved characterization of transmitted integrase resistance.
• It calls for engagement among providers, researchers, and policymakers.

Main Results:

• Transmitted integrase resistance characterization, detection, and clinical impact require further investigation.
• Current guidelines for integrase resistance testing before ART initiation may need reevaluation.
• The optimal approach to integrase resistance testing presents a significant challenge.

Conclusions:

• Further research on transmitted integrase resistance is essential for guiding clinical practice.
• Providers face challenges in deciding when and if to test for integrase resistance.
• A collaborative effort is needed to address the evolving understanding of integrase resistance and its management.