Point-of-care tests for HIV drug resistance monitoring: an update of the literature and future viewpoints.

INTRODUCTION

HIV drug resistance (HIVDR) threatens global antiretroviral therapy (ART) success, especially as treatment scales up in resource-limited settings (RLS). Conventional genotypic HIVDR testing relies on complex instrumentation and often involves long turnaround time, creating critical gaps in managing virologic failure. Point-of-care test (POCT) technologies offer the potential of same-day resistance detection and immediate treatment optimization at the site of care.

AREAS COVERED: This review examines potential HIVDR POCT technologies, with primary focus on advances from 2022 to 2025. It evaluates both established platforms and emerging approaches. Each technology is assessed against WHO REASSURED criteria for point-of-care diagnostics. It also summarizes the relevant clinical validation data, early field implementation experiences, and their feasibility of integration into existing laboratory systems in low- to middle-income countries (LMICs).

EXPERT OPINION: While no single platform currently fulfills all REASSURED criteria, several show strong potentials for near-term implementation, particularly OLA-Simple. Multi-country validation studies support its utility; however, PCR dependence still limits POC usage. Key challenges remain, including limited HIVDR mutations coverage, reliance on complex lab instrumentation, and high costs that hinder scalability and long-term sustainability. By 2030, routinized HIVDR POCT could transform HIV care by enabling real-time treatment decisions, even in RLS or LMICs.