Utilizing HIV Proviral DNA to Assess for the Presence of HIV Drug Resistance

The improved efficacy and tolerability of newer antiretroviral drugs, as well as the introduction of long-acting regimens, have prompted more frequent therapy switches in individuals on suppressive antiretroviral therapy (ART). For these individuals, the assessment of HIV drug resistance using DNA from peripheral blood lymphocytes has become increasingly popular. However, compared with HIV RNA-based analyses, implementation of HIV DNA testing as an alternative approach in clinical care requires new documented quality-assessment procedures and clinical validation. Furthermore, the use of HIV DNA to assess drug resistance has some distinct technical and biologic challenges that are relevant to the clinical management of people with HIV. This Viewpoint article addresses the issues relevant to clinical virologists and treating physicians for the interpretation of drug-resistance testing or subtype assessment based on DNA analysis, when HIV RNA genotypic assessment is not possible.