Thus, the potential sequential use of integrase inhibitors may be problematic, and the use of DTG in second-line regimens after resistance has developed against either RAL or EVG may ultimately represent a hazard to the long-term performance of DTG in the clinic. Of course, the choice of which INSTI to use in first-line regimens will be made by physicians in consultation with their selleck chemical patients based on considerations {Selleck Anti-infection Compound Library|Selleck Antiinfection Compound Library|Selleck Anti-infection Compound Library|Selleck Antiinfection Compound Library|Selleckchem Anti-infection Compound Library|Selleckchem Antiinfection Compound Library|Selleckchem Anti-infection Compound Library|Selleckchem Antiinfection Compound Library|Anti-infection Compound Library|Antiinfection Compound Library|Anti-infection Compound Library|Antiinfection Compound Library|Anti-infection Compound Library|Antiinfection Compound Library|Anti-infection Compound Library|Antiinfection Compound Library|Anti-infection Compound Library|Antiinfection Compound Library|Anti-infection Compound Library|Antiinfection Compound Library|Anti-infection Compound Library|Antiinfection Compound Library|Anti-infection Compound Library|Antiinfection Compound Library|Anti-infection Compound Library|Antiinfection Compound Library|buy Anti-infection Compound Library|Anti-infection Compound Library ic50|Anti-infection Compound Library price|Anti-infection Compound Library cost|Anti-infection Compound Library solubility dmso|Anti-infection Compound Library purchase|Anti-infection Compound Library manufacturer|Anti-infection Compound Library research buy|Anti-infection Compound Library order|Anti-infection Compound Library mouse|Anti-infection Compound Library chemical structure|Anti-infection Compound Library mw|Anti-infection Compound Library molecular weight|Anti-infection Compound Library datasheet|Anti-infection Compound Library supplier|Anti-infection Compound Library in vitro|Anti-infection Compound Library cell line|Anti-infection Compound Library concentration|Anti-infection Compound Library nmr|Anti-infection Compound Library in vivo|Anti-infection Compound Library clinical trial|Anti-infection Compound Library cell assay|Anti-infection Compound Library screening|Anti-infection Compound Library high throughput|buy Antiinfection Compound Library|Antiinfection Compound Library ic50|Antiinfection Compound Library price|Antiinfection Compound Library cost|Antiinfection Compound Library solubility dmso|Antiinfection Compound Library purchase|Antiinfection Compound Library manufacturer|Antiinfection Compound Library research buy|Antiinfection Compound Library order|Antiinfection Compound Library chemical structure|Antiinfection Compound Library datasheet|Antiinfection Compound Library supplier|Antiinfection Compound Library in vitro|Antiinfection Compound Library cell line|Antiinfection Compound Library concentration|Antiinfection Compound Library clinical trial|Antiinfection Compound Library cell assay|Antiinfection Compound Library screening|Antiinfection Compound Library high throughput|Anti-infection Compound high throughput screening| of drug efficacy, tolerability, safety, and ease of dosing. A summary of resistance pathways involving the use of various INSTIs to treat patients in first-line therapy can be found in Table 2. Table 2 Representation of the potential

evolution of HIV-1 following therapy of previously treatment-naïve individuals with raltegravir, elvitegravir, or dolutegravir Treatment-naïve patients Treatment initiation Primary resistance mutations Compensatory mutations Clinical outcome Raltegravir/elvitegravir Ferroptosis inhibitor E92Q, Y143R/C, N155H, Q148R/H/K Y143C/T97A; Y143R/T97A; Y143G/L74M/T97A; Y143C/L74 M/T97A/E138A Virological failure   N155H/L74M; E92Q/N155H

  E92Q/T66I; E92Q/S153A; E92Q/H51Y/L68V   Q148H/K/R + E138A/K; Q148H/K/R + G140S/A; Q148H/E138A/G140S/Y143H Dolutegravir R263 K None Viral suppression In rare cases, the emergence of resistance mutations in patients treated with raltegravir or elvitegravir can lead to virological failure (top). Virological failure with resistance mutations in treatment-naïve patients treated with dolutegravir has not been reported (bottom) Conclusion INSTIs are the most recent class of antiretroviral drugs. INSTIs can and should be used as part of first- and second-line regimens to treat individuals living with HIV. Due to its high genetic barrier for resistance, Oxymatrine DTG may be used to treat patients who have previously failed treatment with RAL or EVG, but only under the circumstances described above. Overall, INSTIs are a major advance in the management of individuals living with HIV. Acknowledgments This work was supported

by an unrestricted educational grant from Gilead Sciences Inc. We thank Ms. Tamar Veres for excellent editorial assistance. Ms. Veres was employed at the McGill University AIDS Centre through funding provided by Gilead Sciences Inc. Dr. Mark A Wainberg is the guarantor for this article, and takes responsibility for the integrity of the work as a whole. Conflict of interest Dr. Mesplède and Dr. Wainberg have no conflicts of interest to disclose. Compliance with ethics guidelines The analysis in this article is based on previously conducted studies, and does not involve any new studies of human or animal subjects performed by any of the authors. Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited. Electronic supplementary material Below is the link to the electronic supplementary material.