REVIEW – April 2024

HIV and HCV – treatment and drug resistance


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At the moment, there are relatively effective antiretroviral (ARV) and direct-acting antiviral (DAA) drugs that prevent the replication of HIV and HCV, respectively. Unfortunately, in the case of HIV, these drugs are not able to eradicate the virus. However, people who have successfully treated by DAA drugs are generally believed to be cured of HCV infection. Drug resistance also plays an important role in the treatment of both viruses. HIV drug resistance has been studied for a long time, and it is known that the presence of mutations before treatment initiation significantly affects the success of ARV treatment. Thus, it is important to know the proportion of transmitted HIV drug resistance in the population. In Estonia, the level of transmitted HIV drug resistance has been shown an increasing trend in recent years, but has remained relatively low, and therefore pre-treatment testing is not currently used. However, it should be noted that the transmitted HIV drug resistance study of year 2020 found the first case of resistance mutation against integrase inhibitors, the newer ARV class. Unlike HIV, there is no strong consensus on the impact of HCV drug resistance mutations on the DAA treatment outcome, and their consideration in treatment decisions is more complexed comprehending multiple factors. In summary, drug resistance of both viruses needs dynamic monitoring to ensure the best possible treatment for people living with HIV and/or HCV.