European recommendations for the clinical use of HIV drug resistance testing: 2011 update

Anne Mieke Vandamme*, Ricardo J. Camacho, Francesca Ceccherini-Silberstein, Andrea De Luca, Lucia Palmisano, Dimitrios Paraskevis, Roger Paredes, Mario Poljak, Jean Claude Schmit, Vincent Soriano, Hauke Walter, Anders Sönnerborg, Mounir Ait-Khaled, Jan Albert, Birgitta Åsjö, Lee Bacheler, Denes Banhegyi, Charles Boucher, Françoise Brun-Vézinet, Bonaventura ClotetMarie Pierre De Béthune, Stéphane De Wit, Stephan Dressler, Rob Elston, José Gatell, Anna Maria Geretti, Jan Gerstoft, Huldrych F. Günthard, William W. Hall, Daria Hazuda, Andrzej Horban, Djordje Jevtovic, Rolf Kaiser, Max Lataillade, Jens D. Lundgren, Natalia Marlowe, Laura Maroldo, Michael Miller, Claus Nielsen, Carlo Federico Perno, Chris Petropoulos, Andrew Phillips, Jonathan Schapiro, Rob Schuurman, Birgitte B. Simen, Christoph Stephan, Martin Stürmer, Jukka Suni, Eugenio Teofilo, Tengiz Tsertsvadze, Mike Westby, Sabine Yerly, Mike Youle

*Corresponding author for this work

    Research output: Contribution to journalReview articlepeer-review

    123 Citations (Scopus)


    The European HIV Drug Resistance Guidelines Panel, established to make recommendations to clinicians and virologists, felt that sufficient new information has become available to warrant an update of its recommendations, explained in both pocket guidelines and this full paper. The Panel makes the following recommendations concerning the indications for resistance testing: for HIV-1 (i) test earliest sample for protease and reverse transcriptase drug resistance in drug-naive patients with acute or chronic infection; (ii) test protease and reverse transcriptase drug resistance at virologic failure, and other drug targets (integrase and envelope) if such drugs were part of the failing regimen; (iii) consider testing for CCR5 tropism at virologic failure or when a change of therapy has to be made in absence of detectable viral load, and in the latter case test DNA or last detectable plasma RNA; (iv) consider testing earliest detectable plasma RNA when a successful nonnucleoside reverse transcriptase inhibitor-containing therapy was inappropriately interrupted; (v) genotype source patient when postexposure prophylaxis is considered; for HIV-2, (vi) consider resistance testing where treatment change is needed after treatment failure. The Panel recommends genotyping in most situations, using updated and clinically evaluated interpretation systems. It is mandatory that laboratories performing HIV resistance tests take part regularly in external quality assurance programs, and that they consider storing samples in situations where resistance testing cannot be performed as recommended. Similarly, it is necessary that HIV clinicians and virologists take part in continuous education and discuss problematic clinical cases. Indeed, resistance test results should be used in the context of all other clinically relevant information for predicting therapy response.

    Original languageEnglish
    Pages (from-to)77-108
    Number of pages32
    JournalAIDS Reviews
    Issue number2
    Publication statusPublished - Apr 2011


    • Antiviral therapy
    • Drug resistance testing
    • Genotype
    • Guidelines
    • HIV
    • Phenotype


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