IAS-USA update drug resistance mutations (2025)
29 May 2025. Related: Guidelines, Drug resistance.
Simon Collins, HIV i-Base
This 2025 edition of the International Antiviral Society–USA (IAS–USA) drug resistance mutations list updates the November 2022 recommendations.
A summary of new drug resistance includes several new mutations in integrase. See Table 1 below.
Other changes include the addition of figure bars and user notes for the entry inhibitors fostemsavir and ibalizumab.
Antiretroviral drugs that are no longer recommended or manufactured are now listed at the bottom of the drug class and are shaded in grey. Their user notes are retained for historical reference.
Table 1. Summary of mutation updates to the 2025 figure bars.
| Drug | Figure bar changes (mutation type) |
| Doravirine | Added A98G (minor) |
| Dolutegravir | Added S147G (minor) |
| Cabotegravir | Added L74I (major), but relevant for subtype A6 only. |
| Lenacapavir |
Added K70H (major) Updated K70N (major) Updated L56I (major) Updated N74D (major) |
| Raltegravir |
Added G118R (major) Added G140C (minor) |
| Elvitegravir |
Added G118R (major) Added E138A/K (minor) Added G140A/C/S (minor) |
References
- Wensing AM et al. 2025 Update of the Drug Resistance Mutations. Topics in HIV Medicine. Volume 33, Issue 2, (May 2025).
https://www.iasusa.org/wp-content/uploads/2025/05/33-2-457.pdf (PDF)