Antiviral Resistance Testing in 2024: Shifting From Phenotypic to Genotypic Methods
This mini-review provides a practical update on clinical antiviral resistance testing across six major viruses: HSV, CMV, HIV, influenza, HBV, and HCV. The field has broadly shifted from phenotypic to genotypic methods as first-line testing, with NGS increasingly replacing Sanger sequencing. The author highlights an unresolved question for clinical laboratories: the clinical significance of minority resistance variants detected by deep sequencing, which may or may not predict treatment failure depending on the viral context.
The original study
Practical updates in clinical antiviral resistance testing.
- Authors
- Wang H
- Journal
- Journal of clinical microbiology
- Type
- Journal Article, Review
- PMID
- 39051778
Original abstract
The laboratory diagnosis of antiviral resistance is a quickly changing field due to new drug availability, the sunsetting of older drugs, the development of novel technologies, rapid viral evolution, and the financial/logistic pressures of the clinical laboratory. This mini-review summarizes the current state of clinically available antiviral resistance testing in the United States in 2024, covering the most commonly used test methods, mechanisms, and clinical indications for herpes simplex virus, cytomegalovirus, human immunodeficiency virus, influenza, hepatitis B virus, and hepatitis C virus drug resistance testing. Common themes include the move away from phenotypic to genotypic methods for first-line clinical testing, as well as uncertainty surrounding the clinical meaningfulness of minority variant detection as next-generation sequencing methods have become more commonplace.