The association of HIV susceptibility testing with survival among HIV-infected patients receiving antiretroviral therapy: a cohort study.
BACKGROUND
HIV-1 genotypic and phenotypic susceptibility testing (GPT) optimizes antiretroviral selection, but its effect on survival is unknown.


OBJECTIVE
To evaluate the association between GPT and survival.


METHODS
Cohort study.


METHODS
10 U.S. HIV clinics.


METHODS
2699 HIV-infected patients eligible for GPT (plasma HIV RNA level >1000 copies/mL) seen from 1999 through 2005.


METHODS
Demographic characteristics, clinical factors, GPT use, all-cause mortality, and crude and adjusted hazard ratios (HRs) for the association of GPT with survival.


RESULTS
Patients were followed for a median of 3.3 years; 915 (34%) had GPT. Patients who had GPT had lower mortality rates than those who did not (2.0 vs. 2.7 deaths per 100 person-years). In standard Cox models, GPT was associated with improved survival (adjusted HR, 0.69 [95% CI, 0.51 to 0.94]; P = 0.017) after controlling for demographic characteristics, CD4+ cell count, HIV RNA level, and intensity of clinical follow-up. In subgroup analyses, GPT was associated with improved survival for the 2107 highly active antiretroviral therapy (HAART)-experienced patients (2.2 vs. 3.2 deaths per 100 person-years for patients who had GPT vs. those who did not have GPT; adjusted HR, 0.60 [CI, 0.43 to 0.82]; P = 0.002) and for the 921 triple antiretroviral class-experienced patients (2.1 vs. 3.1 deaths per 100 person-years; adjusted HR, 0.61 [CI 0.40 to 0.93]; P = 0.022). Marginal structural models supported associations between GPT and improved survival in the overall cohort (adjusted HR, 0.54; P = 0.001) and in the HAART-experienced group (adjusted HR, 0.56; P = 0.003).


CONCLUSIONS
Use of GPT was not randomized. Residual confounding may exist.


CONCLUSIONS
Use of GPT was independently associated with improved survival among HAART-experienced patients.


BACKGROUND
Centers for Disease Control and Prevention.
Palella
Frank J
FJ
Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA. f-palella@northwestern.edu
Armon
Carl
C
Buchacz
Kate
K
Cole
Stephen R
SR
Chmiel
Joan S
JS
Novak
Richard M
RM
Wood
Kathleen
K
Moorman
Anne C
AC
Brooks
John T
JT
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D002423:Cause of Death; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality* / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D019370:Observation; D010641:Phenotype; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012367:RNA, Viral; D012307:Risk Factors
D012367:RNA, Viral