Journal: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Article Title: Design and Evaluation of Next-Generation HIV Genotyping for Detection of Resistance Mutations to 28 Antiretroviral Drugs Across 5 Major Classes Including Lenacapavir
doi: 10.1093/cid/ciaf458
Figure Lengend Snippet: LEN-resistance mutation detection by PHG. A , Pipeline of PHG. HIV RNA is extracted from blood plasma specimen and amplified. The amplified products are then equimolarly multiplexed and sequenced using a palm-sized portable nanopore sequencer. The resultant raw-sequencing data of full-length capsid and pol gene are input to PHG's cloud platform, accessible at https://hida.usc.edu/phg , which outputs drug-resistance mutations, drug resistance, linked cross-class drug-resistance mutations, and linked cross-class drug resistance. An example of PHG's output shows a drug-resistance mutation denoted by a red circle present at 100% frequency among raw reads; while another resistance mutation is present at 33% (gray circle), and the linked cross-class resistance mutations are also present at 33%. PHG reports resistance to drugs in 5 classes: CAI, PI, NRTI, NNRTI, and INSTI, along with the resistance level, categorized as high-level resistance (h), intermediate-level resistance (i), low-level resistance (l), and potentially low-level resistance (p). Drug abbreviations are provided in . B , Two major resistance mutations, Q67H and K70R, were detected (red dot, September 2024) in the capsid region following the third LEN injection in study participant NR4574 at the Los Angeles General Medical Center. The background regimen consisted of DRV and FTR, but pharmacy records indicated that these medications were not dispensed during the periods marked by the red horizontal bars (March 2024 and April 2024). The viral loads at the time of resistance-mutation detection (September 2024) and 2 months later (November 2024) were 64 272 copies/mL and 1 249 784 copies/mL, respectively. C , Comparison of number of drug-resistance mutations detected by PHG (blue) versus standard-care genotyping (gray, Quest Diagnostics: HIV-1 Genotype and HIV-1 Integrase Genotype) among study participants at the Los Angeles General Medical Center: NI6515 (1), HO1336 (2), ZU7316 (3), LV1927 (4), OQ0202 (5), BX5409 (6), KD6313 (7), GH5866 (8), MX3923 (9), FS5399 (10), QJ2545 (11), FE5063 (12), DZ4954 (13), WG8527 (14), NW1918 (15), YF3154 (16), JP3697 (17), DA9544 (18), KG6198 (19), PL6833 (20), XT3525 (21), WU7904 (22), and NR4574 (23). D , Drug-resistance mutations (vertical solid lines) and other mutations (vertical dotted lines) within CA, PR, RT, and IN. The list of other mutations is equivalent to the panel of other mutations reported from the standard clinical care testing. PHG detected multiple drug-resistance mutations, including 2 NRTI-resistance mutations (K70T and T215D), 1 NNRTI mutation (Y181C), and 1 INSTI mutation (E157Q). Additionally, PHG identified 5 other PR mutations and 1 other RT mutation. These results were consistent with standard-care genotyping outcome for this participant. From participant NW1918, neither PHG nor standard-care testing detected any drug-resistance mutations. Both methods identified the same set of 8 other mutations, as listed in . PHG and standard-care testing commonly identified 1 NRTI-resistance mutation (M184V) and 1 NNRTI-resistance mutation (V179T) in participant FS5399. PHG detected an additional NRTI-resistance mutation, K70N, as a minority variant present at 18% prevalence. An INSTI-resistance mutation (R263K) was identified by PHG, which was not evaluated through standard-care testing, as INSTI-resistance testing was not conducted at the clinic. In participant WU7904, PHG and standard-care genotyping identified the same set of drug-resistance mutations and other mutations, with the exception of V179I. This mutation was reported by standard-care genotyping only as a mixed base (V179I/V). Abbreviations: BIC, bictegravir; CA, capsid; CAI, capsid assembly inhibitor; DRV, darunavir; DTG, dolutegravir; EVG, elvitegravir; FTC, emtricitabine; FTR, fostemsavir; HIV, human immunodeficiency virus; IN, integrase; INSTI, integrase strand transfer inhibitor; LEN, lenacapavir; NRTI, nucleoside reverse transcriptase inhibitor; NNRTI, nonnucleoside reverse transcriptase inhibitor; PHG, portable HIV genotyping; PI, protease inhibitor; PR, protease; RT, reverse transcriptase; RT-PCR, reverse-transcription polymerase chain reaction; TAF, tenofovir alafenamide.
Article Snippet: Demographic and clinical data, including ART regimens and standard-care genotyping test results (Quest Diagnostics: HIV-1 Genotype and HIV-1 Integrase Genotype), were collected from medical records.
Techniques: Mutagenesis, Clinical Proteomics, Amplification, Sequencing, Injection, Medications, Comparison, Variant Assay, Virus, Reverse Transcription, Protease Inhibitor, Reverse Transcription Polymerase Chain Reaction, Polymerase Chain Reaction