An international panel of AIDS experts has established a broad set of recommendations for drug resistance testing in patients infected with human immunodeficiency virus (HIV), published in the May 10 issue of the Journal of the American Medical Association (JAMA).
Among its conclusions, the panel presents recommendations for resistance testing in the development of new drug regimens following treatment failure, and in developing therapy for pregnant women infected with HIV.
"HIV drug resistance testing has become a part of the standard management of patients with HIV, helping to determine what drugs will or will not work," said Douglas Richman, M.D., professor of Medicine and Pathology at the UCSD School of Medicine and the Veterans Affairs Medical Center in San Diego, was vice-chair of the panel and senior author of the paper. "However, how to use these tests optimally has been a moving target. We developed these guidelines based on all the most current data to help physicians use the tests more efficiently in designing effective drug therapies for people with HIV."
Dr. Richman is also a member of the Board of Directors of the International AIDS Society—USA, the not-for-profit HIV education organization that convened the panel and sponsored the report. The Resistance Testing Panel was chaired by Martin Hirsch, M.D., Professor of Medicine at Harvard University School of Medicine.
"Several recent studies have shown that the use of HIV drug resistance testing can aid in the management of certain HIV-infected patients whose drug regimens are failing," said Hirsch. "When used together with expert interpretation, these assays can help physicians choose more effective regimens to suppress virus replication."
As Hirsch notes, an increasingly common problem in the treatment of HIV is failure of a drug regimen after a period of success. It has been shown that in many cases this is due to the onset of HIV resistance to certain drugs. Since the patient may still be responding to some drugs in the regimen, the panel strongly recommends resistance testing for patients, in whom treatment is failing, to pinpoint which drugs might still be effective before designing a new treatment.
The panel also recommends testing in pregnant women with HIV infection in order to develop drug regimens that will decrease the risk of transmission of the virus, or of drug resistant virus, to the unborn baby during pregnancy.
The panel recommends that physicians consider resistance testing for patients who are infected but have not yet received any treatment, whether they are recently infected or have established infection. However, they note that data are not compelling enough to recommend routine testing for all patients in this category. Although testing might be useful, they urge physicians to use their judgement and monitor the patient carefully for signs of drug resistance once treatment has been initiated.
Besides Richman and Hirsch, panelists were Francoise Brun-Vezinet, M.D., Hopital Bichat-Claude Bernard, Paris; Richard D'Aquila, M.D., Harvard Medical School; Scott Hammer, M.D., Columbia University College of Physicians and Surgeons; Victoria Johnson, M.D., University of Alabama at Birmingham School of Medicine and Birmingham Veterans Affairs Medical Center; Daniel Kuritzkes, M.D., University of Colorado Health Sciences Center; Clive Loveday, M.D., Ph.D., The Royal Free Hospital Medical School, London.
Also, John Mellors, M.D., University of Pittsburgh and Veterans Affairs Medical Center, Pittsburgh; Bonaventura Clotet, M.D., Ph.D., Fundacio IrsaCAIXA and HIV Unit, Hospital Universitari Germans Trias I Pujol, Barcelona, Spain; Brian Conway, M.D., Viridae Clinical Sciences and University of British Columbia; Lisa Demeter, M.D., University of Rochester; Stefano Vella, M.D., Istituto Superiore di Sanita, Rome, Italy; and Donna Jacobsen, International AIDS Society -- USA, San Francisco.
Media contacts:
Leslie Franz, UCSD
619-543-6163
Donna Jacobsen, International AIDS Society—USA
415-561-6720
Journal
JAMA