2025 update of the drug resistance mutations in HIV-1

Abstract

Certain mutations in HIV-1 that emerge during exposure to antiretroviral drugs may have varied impact on the effectiveness of current and subsequent treatments for HIV. This 2025 edition of the International Antiviral Society-USA (IAS-USA) drug resistance mutations list updates the Figure last published in November 2022 based on new data that have become available. The mutations listed are those that have been identified by specific criteria to contribute to a reduced virologic response to currently available antiretroviral drugs. The Figure is designed to assist practitioners in identifying key mutations associated with resistance to antiretroviral drugs, and therefore, to consider when making clinical decisions regarding the components of an initial antiretroviral regimen and changing a regimen in the settings of avoiding toxicity, regimen simplification, or previous or current virologic failure.