—We read with great interest a recent report by Le Hingrat and colleagues [ ] of a new mechanism of human immunodeficiency virus (HIV)-2 resistance against integrase inhibitors through the development of 5 amino acid insertions within integrase coding sequences. Integrase inhibitors are currently the leading class for antiretroviral treatment initiation [ ]. Insertions in the integrase of HIV-2 conferred various levels of resistance against integrase strand transfer inhibitors [ ]. Insertions had been previously described in the context of HIV-1 drug resistance against protease and reverse transcriptase, but not integrase inhibitors [ ]. To the best of our knowledge, there has not been any report of integrase insertion in HIV-1, which suggests that this type of genetic alteration is specific to HIV-2. Altogether, the findings by Le Hingrat and colleagues are very significant.
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