Resistance Testing Recommended in New IAS -- USA Guidelines

New guidelines from the International AIDS Society-USA recommend HIV drug-resistance testing (either phenotypic or genotypic) in a number of patient-care situations; the guidelines were published in JAMA, the Journal of the American Medical Association, May 10, 2000.(1) Each recommendation reflects a unanimous vote of a 13-member international panel of expert physicians.

From the abstract: "Conclusions: Emerging data indicate that despite limitations, resistance testing should be incorporated into patient management in some settings. Resistance testing is recommended to help guide the choice of new regimens after treatment failure and for guiding therapy for pregnant women. It should be considered in treatment-naive patients with established infection, but cannot be firmly recommended in this setting. Testing also should be considered prior to initiating therapy in patients with acute HIV infection, although therapy should not be delayed pending the results. Expert interpretation is recommended given the complexity of results and assay limitations."

Besides the value of the recommendations themselves, this paper is important as the most authoritative review on resistance testing at this time (although it will probably become obsolete later this year). It discusses the different tests, and the many complexities around their use. It includes a chart showing the major resistance mutations for all 14 of the currently approved antiretrovirals. It reviews the current state of knowledge of resistance testing through April 2000, with 94 references to major publications on HIV drug resistance.

Also see the editorial(2) on resistance testing in the same issue.

Note: The U.S. Health and Human Services guidelines, updated January 28, also recommend resistance testing in some circumstances -- but are much less detailed than those of the new IAS guidelines. The HHS guidelines are available at http://www.hivatis.org/trtgdlns.html

References

1. Hirsch MS, Brun-Vezinet F, D'Aquila RT and others. Antiretroviral Drug Resistance Testing in Adult HIV-1 Infection: Recommendations of an International AIDS Society -- USA Panel. JAMA. May 10, 2000; volume 283, number 18, pages 2417-2426. This document, and the editorial below, are available at the JAMA HIV page, http://www.ama-assn.org/special/hiv/library/scan/may00/may00a.htm

2. Flexner, C. HIV Genotype and Phenotype -- Arresting Resistance? JAMA. May 10, 2000; volume 283, number 18, pages 2442-2444.

ISSN # 1052-4207

Copyright 2000 by John S. James. Permission granted for noncommercial reproduction, provided that our address and phone number are included if more than short quotations are used.

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