Radata - implementation of resistance analysis and expert advice for optimized HAART switches in general practice of HIV-infected individuals via a compiling internet presence.
BACKGROUND
HIV-infected patients fail viral load suppression, because resistance against antiretroviral drugs arises or for other reasons. HIV-resistance analyses can aid to achieve effective HAART regimen. Furthermore, clinical benefits from genotyping in study settings are significantly higher for treating physicians, who can include external advice from HIV-experts into HAART switch.


OBJECTIVE
To develop a compiling internet presence to provide expert advice for HAART switch in general practice of HIV-infected individuals after therapy failure. -


METHODS
A multifactorial (genotyping, drug monitoring, adherence, expert advice) interdisciplinary internet service (www.radata.de) with an associated server hosted database.


METHODS
HIV-infected patients after failure to HAART are eligible for registration to the Radata project. Genotyping is performed according to protocols specific for each participating institution. Therapeutic drug monitoring (NNRTIs, PIs) follows setting for drug level detection by mass spectrometry. An adherence self-report is completed by every patient. Clinical documentation is provided by the treating Primary Care Physician. Clinical expert advice for implementation into HAART switch in daily clinical practice for treating physicians is provided by HIV-experts according to data obtained. Clinical and laboratory follow-up visits are scheduled firstly 4 weeks after HAART switch and three monthly afterwards, over a period of one year.


RESULTS
Technical resources and a compiling internet presence for generation of resistance analysis based expert advice were developed. Initially, 7 HIV-treatment centres, 7 laboratories and 17 HIV advisors contribute to Radata database project. 15 patients were enrolled during test period. 30 expert advices were generated during the test phase. Expert advice was provided in 6 weeks median for implementation into HAART switch. 13 out of 15 expert advices were implemented into HAART switch by treating Primary Care Physicians.


CONCLUSIONS
Radata is a novel database concept with features to generate expert advice for implementation into HAART switch of HIV-infected subjects. A test period has shown, that the concept is technically approved to fit all requirements with regard to data collection, evaluation and to generate expert advice for therapy switch in daily clinical practice.
Paech
V
V
Ifi-Institute for interdisciplinary Infectiology and Immunology GmbH, General Hospital St. Georg, Hamburg, Germany.
Lorenzen
T
T
Stoehr
A
A
Plettenberg
A
A
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D016208:Databases, Factual; D016903:Drug Monitoring / Q000379:methods*; D024882:Drug Resistance, Viral; D005260:Female; D005838:Genotype; D006678:HIV / Q000235:genetics / Q000502:physiology; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D020407:Internet; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D011795:Surveys and Questionnaires; D017211:Treatment Failure; D019562:Viral Load