| Summary: | This guideline was issued by the New York State Department of Health AIDS Institute Clinical Guidelines Program, Medical Care Criteria Committee. The interpretation of HIV resistance assays is one of the most challenging tasks clinicians encounter when caring for patients with HIV and is crucial for tailoring an effective therapeutic ART regimen. The replicative mechanisms of HIV lack proof-reading capacity, making them error-prone and subject to cumulative mutations (i.e., changes in its genetic sequence). This lack of replicative fidelity, coupled with the selective pressure of sub-therapeutic drug levels, can lead to the development of clinically significant (i.e., resistance-bearing) mutations. When determining the optimal regimen for achieving viral suppression, clinicians should perform genotypic resistance testing that includes the protease, reverse transcriptase, and integrase genes at baseline, whether ART is being initiated or not. In patients experiencing treatment failure or incomplete viral suppression; such testing should be performed while patients are still on therapy, but no later than 4 weeks after stopping ART, given the rapid return of wild-type virus. Perform co-receptor tropism testing prior to initiation of a CCR5 antagonist. If fusion inhibitor resistance is suspected, that test should be obtained as a supplement to the other genotypic resistance tests
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