Advantages of predicted phenotypes and statistical learning models in inferring virological response to antiretroviral therapy from HIV genotype.
BACKGROUND
Inferring response to antiretroviral therapy from the viral genotype alone is challenging. The utility of an intermediate step of predicting in vitro drug susceptibility is currently controversial. Here, we provide a retrospective comparison of approaches using either genotype or predicted phenotypes alone, or in combination.


METHODS
Treatment change episodes were extracted from two large databases from the USA (Stanford-California) and Europe (EuResistDB) comprising data from 6,706 and 13,811 patients, respectively. Response to antiretroviral treatment was dichotomized according to two definitions. Using the viral sequence and the treatment regimen as input, three expert algorithms (ANRS, Rega and HIVdb) were used to generate genotype-based encodings and VircoTYPE() 4.0 (Virco BVBA, Mechelen, Belgium) was used to generate a predicted -phenotype-based encoding. Single drug classifications were combined into a treatment score via simple summation and statistical learning using random forests. Classification performance was studied on Stanford-California data using cross-validation and, in addition, on the independent EuResistDB data.


RESULTS
In all experiments, predicted phenotype was among the most sensitive approaches. Combining single drug classifications by statistical learning was significantly superior to unweighted summation (P<2.2x10(-16)). Classification performance could be increased further by combining predicted phenotypes and expert encodings but not by combinations of expert encodings alone. These results were confirmed on an independent test set comprising data solely from EuResistDB.


CONCLUSIONS
This study demonstrates consistent performance advantages in utilizing predicted phenotype in most scenarios over methods based on genotype alone in inferring virological response. Moreover, all approaches under study benefit significantly from statistical learning for merging single drug classifications into treatment scores.
Computational Biology and Applied Algorithmics, Max Planck Institute for Informatics, Saarbr product operatorcken, Germany. altmann@mpi-inf.mpg.de
André
A
Altmann
Tobias
T
Sing
Hans
H
Vermeiren
Bart
B
Winters
Elke
E
Van Craenenbroeck
Koen
K
Van der Borght
Soo-Yon
SY
Rhee
Robert W
RW
Shafer
Eugen
E
Schülter
Rolf
R
Kaiser
Yardena
Y
Peres
Anders
A
Sönnerborg
W Jeffrey
WJ
Fessel
Francesca
F
Incardona
Maurizio
M
Zazzi
Lee
L
Bacheler
Herman
H
Van Vlijmen
Thomas
T
Lengauer
D000465:Algorithms; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003198:Computer Simulation; D004359:Drug Therapy, Combination; D006678:HIV / Q000187:drug effects / Q000235:genetics; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology; D006801:Humans; D008954:Models, Biological; D015233:Models, Statistical; D011237:Predictive Value of Tests; D017421:Sequence Analysis
D044966:Anti-Retroviral Agents