Evidence map›Paper›PMID 40541216›Full record

ReviewThe lancet. HIV2025

Do we need routine integrase resistance testing before starting antiretroviral therapy?

Rami Kantor, Alice K Pau, Michael J Kozal, Emily P Hyle

Abstract readReview
In one paragraph

Review in The lancet. HIV, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Review
  2. Letter to the editor: When do rare events become expected in HIV drug resistance?Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin · 2026
    Article
  3. Two cases of possible transmitted HIV drug resistance to all currently available integrase inhibitors, the Netherlands, 2025.Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin · 2026
    Article
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Rami KantorDivision of Infectious Diseases, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA; The Miriam Hospital, Providence, RI, USA. Electronic address: rkantor@brown.edu.
Alice K PauNational Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
Michael J KozalDivision of Infectious Diseases & Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Emily P HyleDivision of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.

Funding

Translational ScienceP30AI042853 · NIAID · MIRIAM HOSPITAL · PI LARRY K BROWN · 1998 to 2026
$51.7M
Development and application of a new simulation model for COVID-19R01AI042006 · NIAID · MASSACHUSETTS GENERAL HOSPITAL · PI Kenneth Alan Freedberg, Anne Neilan · 1998 to 2026
$12.9M
Addressing HIV drug resistance research gaps in a cohort of perinatally infected Kenyan children and adolescentsR01AI147333 · NIAID · MIRIAM HOSPITAL · PI KANTOR, RAMI, VREEMAN, RACHEL CHRISTINE · 2019 to 2024
$3.9M
Real Time Phylogeny and Contact Tracing to Disrupt HIV TransmissionR01AI136058 · NIAID · MIRIAM HOSPITAL · PI KANTOR, RAMI · 2018 to 2022
$3.4M
HIV Drug Resistance in the New Antiretroviral Therapy Era in KenyaR01AI186632 · NIAID · MIRIAM HOSPITAL · PI Rami Kantor · 2024 to 2026
$2.0M
Real Time Phylogeny and Contact Tracing to Disrupt HIV TransmissionR37AI136058 · NIAID · MIRIAM HOSPITAL · PI Rami Kantor · 2025 to 2026
$1.5M
HIV Drug Resistance, Monitoring and TransmissionK24AI134359 · NIAID · MIRIAM HOSPITAL · PI Rami Kantor · 2018 to 2026
$1.3M
NIAID NIH HHS K24 AI134359NIAID NIH HHS P30 AI042853NIAID NIH HHS R01 AI042006NIAID NIH HHS R01 AI136058NIAID NIH HHS R01 AI147333NIAID NIH HHS R01 AI186632NIAID NIH HHS R37 AI136058
6 · The paper itself

Abstract

Oral second-generation integrase strand transfer inhibitors are now anchor drugs of antiretroviral therapy (ART) globally due to their high resistance barriers. In high-income settings, guidelines recommend routine protease and reverse transcriptase resistance testing before ART initiation but suggest routine integrase resistance testing only for individuals at elevated risk of integrase resistance. Improved characterisation of transmitted integrase resistance, its detection, and its clinical impact will guide future recommendations for clinical decision making. Balancing the need to protect this important drug class against concerns about resource allocation and care complexity presents a substantial challenge. Shifting the responsibility to providers to decide whether and when to test for integrase resistance before ART initiation can be problematic, particularly given the uncertainty around the need to reassess related available recommendations. As our understanding of integrase resistance evolves, prioritising this discussion is essential, and providers, researchers, and policy makers should engage in addressing this important issue.

Indexed as

Anti-HIV AgentsDrug Resistance, ViralHIV-1HIV InfectionsHIV IntegraseHIV Integrase InhibitorsHumansAnti-HIV AgentsHIV IntegraseHIV Integrase Inhibitors

Identifiers

PMID40541216
PMCPMC12265005

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.