Letter to the editor: When do rare events become expected in HIV drug resistance?

Ziad El-Khatib; Maria Wessman; Anders Sönnerborg; Jannik Fonager; Alexander Zoufaly; Gisela Leierer; Ojan Assadian; Bernhard Benka; Ndeindo Ndeikoundam Ngangro; Rami Kantor

doi:10.2807/1560-7917.ES.2026.31.16.2600334

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Letter to the editor: When do rare events become expected in HIV drug resistance?
Ziad El-Khatib^1,2 , Maria Wessman³ , Anders Sönnerborg⁴ , Jannik Fonager⁵ , Alexander Zoufaly⁶ , Gisela Leierer⁷ , Ojan Assadian⁸ , Bernhard Benka⁹ , Ndeindo Ndeikoundam Ngangro¹⁰ , Rami Kantor¹¹
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Affiliations: ¹ Institute for Surveillance & Infectious Disease Epidemiology, Austrian Agency for Health and Food Safety (AGES), Vienna, Austria ² Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden ³ Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark ⁴ Department of Medicine, Karolinska Institutet, Stockholm, Sweden ⁵ Section for Virus Genomics, Department of Virus & Microbiological Preparedness, Statens Serum Institut, Copenhagen, Denmark ⁶ Sigmund Freud Private University, Vienna, Austria ⁷ Department of Dermatology and Venereology, Medical University of Innsbruck, Innsbruck, Austria ⁸ University Hospital Wiener Neustadt, Wiener Neustadt, Austria ⁹ Division of Human Health, Austrian Agency for Health and Food Safety (AGES), Vienna, Austria ¹⁰ Unit of HIV, HIV, hepatitis B/C/D, and STI, The French Public Health Agency, Saint Maurice, France ¹¹ Division of Infectious Diseases, Department of Medicine, Alpert Medical School, Brown University, Providence, United States

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Ziad El-Khatib
ziad.el-khatib ages.at
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Citation style for this article: El-Khatib Ziad, Wessman Maria, Sönnerborg Anders, Fonager Jannik, Zoufaly Alexander, Leierer Gisela, Assadian Ojan, Benka Bernhard, Ndeikoundam Ngangro Ndeindo, Kantor Rami. Letter to the editor: When do rare events become expected in HIV drug resistance?. Euro Surveill. 2026;31(16):pii=2600334. https://doi.org/10.2807/1560-7917.ES.2026.31.16.2600334 Received: 10 Apr 2026; Accepted: 20 Apr 2026

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References

van Kampen J, Voermans J, Soochit W, Mesplède T, van de Laar T, van der Reijden W, et al. Two cases of possible transmitted HIV drug resistance to all currently available integrase inhibitors, the Netherlands, 2025. Euro Surveill. 2026;31(8): 2600108. https://doi.org/10.2807/1560-7917.ES.2026.31.8.2600108 PMID: 41755723
European AIDS Clinical Society (EACS). Guidelines version 12.0. Oct 2023. Available from: https://www.eacsociety.org/media/guidelines-12.0.pdf
Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. Washington DC: United States Department of Human Health and Services; 25 Sep 2025. Available from: https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf
Kantor R, Pau AK, Kozal MJ, Hyle EP. Do we need routine integrase resistance testing before starting antiretroviral therapy? Lancet HIV. 2025;12(9):e664-8. https://doi.org/10.1016/S2352-3018(25)00108-0 PMID: 40541216
World Health Organization (WHO). Global action plan on HIV drug resistance 2017-2021. Geneva: WHO; 1 Jul 2017. Available from: https://www.who.int/publications/i/item/978-92-4-151284-8
European Centre for Disease Prevention and Control (ECDC). HIV/AIDS surveillance in Europe 2024–2023 data. Stockholm: ECDC; 28 Nov 2024. Available from: https://www.ecdc.europa.eu/en/publications-data/hiv-aids-surveillance-europe-2024-2023-data
World Health Organization (WHO). Integrated drug resistance action framework for HIV, hepatitis B and C and sexually transmitted infections, 2026-2030. Geneva: WHO; 19 Nov 2025. Available from: https://www.who.int/publications/i/item/9789240117204
McClure M, Gandhi M. Threat of HIV and tuberculosis drug resistance after US funding cuts. Lancet Infect Dis. 2025;25(5):e256-7. https://doi.org/10.1016/S1473-3099(25)00209-9 PMID: 40122094

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