HIV i-Base

Resistance course: expanded contents

New sections of this expanded contents will be added as the course develops.

Resistance 1: Introduction

1.1 Introduction
1.2 Resistance on a personal level
1.3 Questions about resistance
1.4 Course outline
1.5 Learning objectives
1.6 Introductory reading
1.7 Who produced this resource
1.8 Feedback

Resistance 2: Key concepts: genetics, HIV structure and life cycle

2.1 Recap from previous section
2.2 Introduction to Session 2
2.3 Genetics
2.4 Life cycles and reproduction
2.5 HIV replication
2.6 Section 2: Learning points
2.7 Section 2: evaluation

Resistance 3: Mutations with and without drugs: ’selective pressure’ and ’survival of the fittest‘

3.1 Recap from previous section
3.2 Introduction to Session 3
3.3 Wild type HIV and drug pressure
3.4 Survival of the fittest
3.5 Selective pressure
3.6 Using three drugs in HIV treatment
3.7 Section 3: Learning points
3.8 Section 3: Evaluation

Resistance 4: Resistance tests and interpreting the results

4.1 Recap from previous section
4.2 Introduction to Session 4
4.3 Genotype tests and genotypic resistance: numbers and letters
4.4 Phenotype tests and phenotypic resistance: x-fold resistance
4.5 How are genotype and phenotype resistance related
4.6 Virtual phenotype tests
4.7 Primary and secondary mutations vs major and minor mutations
4.8 Resistance testing practical issues
4.9 Section 4: Learning points
4.10 Section 4: Evaluation

Resistance 5: When to use resistance tests

5.1  Recap of previous section
5.2  Introduction to section 5
5.3  When to use resistance tests
5.4  Which tests to use: genotype or phenotype?
5.5  How to access tests if the guidelines are not followed
5.6  Section 5: Learning points
5.7  Section 5 evaluation

Resistance 6: Research into drug resistance

6.1  Recap from previous section
6.2  Introduction to this section
6.3  Resistance with 3TC monotherapy
6.4  An undetectable viral load stops HIV evolving
6.5  Trends in transmitted drug resistance over time
6.6  Single dose nevirapine during pregnancy
6.7  Importance of resistance testing before starting treatment
6.8  Reinfection/superinfection: catching HIV twice
6.9  Section 6: Learning points
6.10 Section 6: Evaluation


Appendix 1: Questions on resistance
Appendix 2: Supplementary information about genetics
Appendix 3: List of amino acids and their abbreviations
Appendix 4: DNA codes for amino acids
Appendix 5: The HIV genome map
Appendix 6: Stanford Drug Resistance Database online tables
Appendix 7: IAS-USA resistance mutations and cross resistance
Appendix 8: UK Resistance Guidelines (BHIVA) summary
Appendix 9: Examples of resistance test reports
Appendix 10: Recording resistance test results
Expanded resistance course contents
Glossary (resistance)

Figures and tables

Figure 1: Simplified illustration of DNA (S2)
Figure 2: How resistant mutations respond to treatment (S3)
Figure 3: Resistance reduces if treatment is stopped but it remains at low levels (S3)
Figure 4: Combinations with three drugs work against low-level pre-existing resistance (S3)
Figure 5: How genotype and phenotype tests work (S4)

Table 1: Some important drug resistance mutations (S4)
Table 2: Clinical phenotypic cut-off values for VircoType virtual phenotype test (S4)
Table 3: When to use resistance tests (S5)
Table 4: Nucleoside RT inhibitor (NRTI) resistance mutations (Stanford database) (appendix 6)

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