Long-term efficacy of routine access to antiretroviral-resistance testing in HIV type 1-infected patients: results of the clinical efficacy of resistance testing trial.
The long-term efficacy of making resistance testing routinely available to clinicians has not been established. We conducted a clinical trial at 6 US military hospitals in which volunteers infected with human immunodeficiency virus type-1 were randomized to have routine access to phenotype resistance testing (PT arm), access to genotype resistance testing (GT arm), or no access to either test (VB arm). The primary outcome measure was time to persistent treatment failure despite change(s) in antiretroviral therapy (ART) regimen. Overall, routine access to resistance testing did not significantly increase the time to end point. Time to end point was significantly prolonged in the PT arm for subjects with a history of treatment with > or =4 different ART regimens or a history of treatment with nonnucleoside reverse-transcriptase inhibitors before the study, compared with that in the VB arm. These results suggest that routine access to resistance testing can improve long-term virologic outcomes in HIV-infected patients who are treatment experienced but may not impact outcome in patients who are naive to or have had limited experience with ART.
Wegner
Scott A
SA
Tri-Service AIDS Clinical Consortium, US Military HIV Research Program, Walter Reed Army Institute of Research, Rockville, MD 20850, USA. swegner@hivresearch.org
Wallace
Mark R
MR
Aronson
Naomi E
NE
Tasker
Sybil A
SA
Blazes
David L
DL
Tamminga
Cindy
C
Fraser
Susan
S
Dolan
Matthew J
MJ
Stephan
Kevin T
KT
Michael
Nelson L
NL
Jagodzinski
Linda L
LL
Vahey
Maryanne T
MT
Gilcrest
Joyce L
JL
Tracy
LaRee
L
Milazzo
Mark J
MJ
Murphy
Daniel J
DJ
McKenna
Paula
P
Hertogs
Kurt
K
Rinehart
Alex
A
Larder
Brendan
B
Birx
Deborah L
DL
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D013997:Time Factors; D017211:Treatment Failure
D019380:Anti-HIV Agents