Highly Drug-Resistant HIV

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Integrase is a viral enzyme that is essential for HIV type 1 (HIV-1) replication; it catalyzes the insertion of proviral DNA into the host-cell genome. Raltegravir is an integrase inhibitor and specifically inhibits proviral DNA-strand transfer, with potent in vitro activity against HIV-1.
In most patients with highly drug-resistant HIV, the resistance develops because of sequential exposure to HIV drugs in the context of incomplete virologic suppression. The genetic barrier to drug resistance for several of the most important HIV agents is low, requiring only a single point mutation to confer loss of activity. Drug-resistant virus can also be transmitted from person to person, although the transmission of strains resistant to multiple classes of drugs is rare.

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