A 22-year-old woman with HIV presents for follow-up and monitoring on an antiretroviral regimen of rilpivirine-tenofovir DF-emtricitabine. Baseline laboratory studies performed prior to starting antiretroviral therapy showed the CD4 count was 323 cells/mm3, HIV RNA level was 43,250 copies/mL, and there were no mutations on an HIV drug-resistance genotypic assay. She initially achieved an undetectable HIV RNA level, but recently, after some problems with adherence, had two HIV RNA levels greater than 500 copies/mL.
Which one of the following is TRUE regarding HIV drug resistance when virologic failure occurs in patients taking rilpivirine-tenofovir DF-emtricitabine?

Figure 1. Impact of the E138K Mutation on NNRTI Medications
The E138K mutation causes intermediate-level resistance to rilpivirine and low-level resistance to efavirenz, etravirine, and nevirapine; doravirine is not significantly impacted by the E138K mutation.
Source: Illustration by David H. Spach, MD

Figure 2. Impact of the E138K and M184I Mutations on NNRTI Medications
The M184I mutation enhances the impact of the E138K on rilpivirine resistance, but it does not significantly impact doravirine, efavirenz, etravirine, or nevirapine.
Illustration: David H. Spach, MD
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Question Last Updated
January 28th, 2025
January 28th, 2025
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