Academy Exchange

I have come across a question that I am not quite sure how to answer. 

The E138A mutation which causes low level resistance to Rilpiverine also causes integrase resistance of either low level or potential when run through the Stanford Resistance Database and IAS-USA Mutation records. 

However, when I am getting my genotypes back from State or Major Lab company it does not list the E138A as a concern in the Integrase reports. 

My question is what am I missing here? Is this a concern or not. 

I would never put someone with this mutation on Cabenuva or Juluca but is Dovato Ok? Should I be worried about this if I find someone on Dovato and change regime. 

Should I be worked about other integrase combinations with triple drug therapy i.e. inst with dual nRTI therapy, esp lower level for resistance inst combinatiions? 

Thanks in advance for your thoughts

There are two different 138A mutations: one in reverse transcriptase and one in integrase.  There's no single 138A mutation that causes both NNRTI and integrase inhibitor resistance. It sounds like you're talking about the NNRTI mutation based on the lab report.

Keep in mind that the presence of NNRTI mutations (and others as well) increases the likelihood that there also M184V, which may not be detected.  This would make me a little nervous about Dovato.

I have come across a question that I am not quite sure how to answer. 

The E138A mutation which causes low level resistance to Rilpiverine also causes integrase resistance of either low level or potential when run through the Stanford Resistance Database and IAS-USA Mutation records. 

However, when I am getting my genotypes back from State or Major Lab company it does not list the E138A as a concern in the Integrase reports. 

My question is what am I missing here? Is this a concern or not. 

I would never put someone with this mutation on Cabenuva or Juluca but is Dovato Ok? Should I be worried about this if I find someone on Dovato and change regime. 

Should I be worked about other integrase combinations with triple drug therapy i.e. inst with dual nRTI therapy, esp lower level for resistance inst combinatiions? 

Thanks in advance for your thoughts

Thank you for the clarification. 

I suspected it was two seperate location mutations but both named 138A (which is confusing) but had never came across it in this way in the past. Our reports from labs had changed and I had never had a client with the same mutation on both the Integrase and Regular genotypes.

It is good to know about the 184V increased likelyhood. I will add it to my notebook. 

Thank you for response. 

There are two different 138A mutations: one in reverse transcriptase and one in integrase.  There's no single 138A mutation that causes both NNRTI and integrase inhibitor resistance. It sounds like you're talking about the NNRTI mutation based on the lab report.

Keep in mind that the presence of NNRTI mutations (and others as well) increases the likelihood that there also M184V, which may not be detected.  This would make me a little nervous about Dovato.

I have come across a question that I am not quite sure how to answer. 

The E138A mutation which causes low level resistance to Rilpiverine also causes integrase resistance of either low level or potential when run through the Stanford Resistance Database and IAS-USA Mutation records. 

However, when I am getting my genotypes back from State or Major Lab company it does not list the E138A as a concern in the Integrase reports. 

My question is what am I missing here? Is this a concern or not. 

I would never put someone with this mutation on Cabenuva or Juluca but is Dovato Ok? Should I be worried about this if I find someone on Dovato and change regime. 

Should I be worked about other integrase combinations with triple drug therapy i.e. inst with dual nRTI therapy, esp lower level for resistance inst combinatiions? 

Thanks in advance for your thoughts