Novel mechanisms of HIV protease inhibitor resistance

PURPOSE OF REVIEW: Several alternative mechanisms that cause protease inhibitor resistance have been proposed. A summary of the proposed mechanisms and the status regarding their clinical relevance is given. RECENT FINDINGS: At this moment only changes in the cleavage sites of protease (either alone or in the background of protease mutations) have been associated with phenotypic changes in IC50 and virological failure. SUMMARY: Further studies are necessary to unravel the mechanism, the clinical relevance and potential effect of transmission of these cleavage site changes.

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