Integrase strand transfer inhibitors (INSTIs) are the latest class of potent anti-HIV drugs. Currently, three INSTIs have been approved by the US Food and Drug Administration: raltegravir (RAL), elvitegravir (EVG) and dolutegravir (DTG). Resistance mutations to RAL and EVG emerge rapidly, and significant cross-resistance between these compounds has been documented. In addition, limited cross-resistance has been observed among DTG, a newer INSTI, and RAL and EVG even though clinical resistance to DTG, or mutations associated with DTG resistance in treatment-naïve patients, has not yet been observed. This review summarises progress in studies on understanding resistance to DTG, mechanisms of possible resistance to DTG, and reasons for the absence of DTG-associated resistance mutations when the drug has been used in first-line therapy.
The seminal vesicles are paired organs that have a posterior location to the bladder and prostate. A seminal vesicle has a capacity for around 4 ml, and has a length of 5-7 cm. The secretions of seminal vesicles make up 80% of seminal fluid . Primary tumors of the seminal vesicles are very rare and could be benign or malignant and Benign tumors, such as cystadenomas are rarer than malignant ones . They are usually present in second and third decades of life. High-resolution trans-rectal ultrasonography (TRUS) guided biopsy can be useful for assisting the diagnosis. CT scan and MRI are more performing techniques to characterize the lesion of the seminal vesicle . Because of the rarity of these tumors, there is no defined treatment for their management .