title: HIV-1 protease and reverse transcriptase mutations for drug resistance surveillance.
abstract: OBJECTIVE
  Monitoring regional levels of transmitted HIV-1 resistance informs treatment guidelines and provides feedback on the success of HIV-1 prevention efforts. Surveillance programs for estimating the frequency of transmitted resistance are being developed in both industrialized and resource-poor countries. However, such programs will not produce comparable estimates unless a standardized list of drug-resistance mutations is used to define transmitted resistance.
  
  
  METHODS
  In this paper, we outline considerations for developing a list of drug-resistance mutations for epidemiologic estimates of transmitted resistance. First, the mutations should cause or contribute to drug resistance and should develop in persons receiving antiretroviral therapy. Second, the mutations should not occur as polymorphisms in the absence of therapy. Third, the mutation list should be applicable to all group M subtypes. Fourth, the mutation list should be simple, unambiguous, and parsimonious.
  
  
  RESULTS
  Applying these considerations, we developed a list of 31 protease inhibitor-resistance mutations at 14 protease positions, 31 nucleoside reverse transcriptase inhibitor-resistance mutations at 15 reverse transcriptase positions, and 18 non-nucleoside reverse transcriptase inhibitor-resistance mutations at 10 reverse transcriptase positions.
  
  
  CONCLUSIONS
  This list, which should be updated regularly using the same or similar criteria, can be used for genotypic surveillance of transmitted HIV-1 drug resistance.
authors.affiliation: Division of Infectious Diseases, Stanford University, Stanford, California, USA. rshafer@stanford.edu
authors.forename: Robert W
authors.initials: RW
authors.lastname: Shafer
authors.forename: Soo-Yon
authors.initials: SY
authors.lastname: Rhee
authors.forename: Deenan
authors.initials: D
authors.lastname: Pillay
authors.forename: Veronica
authors.initials: V
authors.lastname: Miller
authors.forename: Paul
authors.initials: P
authors.lastname: Sandstrom
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Schapiro
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Kuritzkes
authors.forename: Diane
authors.initials: D
authors.lastname: Bennett
mesh_terms: D019380:Anti-HIV Agents / Q000494:pharmacology; D024882:Drug Resistance, Viral / Q000235:genetics*; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission / Q000821:virology; D016333:HIV Protease / Q000235:genetics*; D017320:HIV Protease Inhibitors / Q000494:pharmacology; D054303:HIV Reverse Transcriptase / Q000235:genetics*; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics*; D006801:Humans; D009154:Mutation; D011110:Polymorphism, Genetic; D018894:Reverse Transcriptase Inhibitors / Q000494:pharmacology
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors; D054303:HIV Reverse Transcriptase; D016333:HIV Protease