Variable prediction of antiretroviral treatment outcome by different systems for interpreting genotypic human immunodeficiency virus type 1 drug resistance.
To determine the variability of genotypic human immunodeficiency virus (HIV) type 1 drug-resistance interpretation by available expert systems and its clinical implications, 261 subjects for whom a potent antiretroviral regimen was failing who were starting salvage therapy were evaluated. The association of the genotypic susceptibility score (GSS) of the salvage regimen, according to 11 interpretation systems, with HIV RNA outcomes for 6 months was examined. GSS was highly variable, as determined by the different interpretation systems, and showed independent correlation with changes from baseline HIV RNA levels at 6 months with 5 systems--Stanford hivdb, GuideLines 3.0, Retrogram 1.4, HIVresistanceWeb, and São Paulo University. Most GSSs predicted virologic response in regimens containing stavudine, lamivudine, efavirenz, or indinavir. Selected systems predicted response in regimens containing didanosine, abacavir, or nelfinavir, and no system predicted outcome of boosted protease inhibitors. GSSs predicted changes in HIV RNA levels better in adherent patients than in nonadherent individuals. Interpretation may be improved, and knowledge should be used uniformly throughout different expert systems.
De Luca
Andrea
A
Institute of Clinical Infectious Diseases, Catholic University, Rome, Italy. andrea.deluca@rm.unicatt.it
Cingolani
Antonella
A
Di Giambenedetto
Simona
S
Trotta
Maria Paola
MP
Baldini
Francesco
F
Rizzo
Maria Gabriella
MG
Bertoli
Ada
A
Liuzzi
Giuseppina
G
Narciso
Pasquale
P
Murri
Rita
R
Ammassari
Adriana
A
Perno
Carlo Federico
CF
Antinori
Andrea
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D024921:Drug Resistance, Multiple, Viral / Q000235:genetics*; D004359:Drug Therapy, Combination; D005103:Expert Systems; D005260:Female; D005544:Forecasting; D005814:Genes, Viral; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D016879:Salvage Therapy; D016896:Treatment Outcome
D019380:Anti-HIV Agents