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.
Tri-Service AIDS Clinical Consortium, US Military HIV Research Program, Walter Reed Army Institute of Research, Rockville, MD 20850, USA. swegner@hivresearch.org
Scott A
SA
Wegner
Mark R
MR
Wallace
Naomi E
NE
Aronson
Sybil A
SA
Tasker
David L
DL
Blazes
Cindy
C
Tamminga
Susan
S
Fraser
Matthew J
MJ
Dolan
Kevin T
KT
Stephan
Nelson L
NL
Michael
Linda L
LL
Jagodzinski
Maryanne T
MT
Vahey
Joyce L
JL
Gilcrest
LaRee
L
Tracy
Mark J
MJ
Milazzo
Daniel J
DJ
Murphy
Paula
P
McKenna
Kurt
K
Hertogs
Alex
A
Rinehart
Brendan
B
Larder
Deborah L
DL
Birx
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