How Does Expert Advice Impact Genotypic Resistance Testing in Clinical Practice?

• Published in: Clinical infectious diseases 2003-09, Vol.37 (5), p.708-713
• Main Authors: Badri, Sheila M., Adeyemi, Oluwatoyin M., Max, Blake E., Zagorski, Brandon M., Barker, David E.
• Format: Article
• Language: English
• Subjects: Adult; Anti-HIV Agents - therapeutic use; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiretroviral Therapy, Highly Active - methods; Antiretroviral Therapy, Highly Active - trends; Antiretrovirals; Antiviral agents; Biological and medical sciences; CD4 Lymphocyte Count; Drug Resistance, Viral - genetics; Female; Genetic mutation; Genotype; Highly active antiretroviral therapy; HIV 1; HIV Infections - drug therapy; HIV Infections - virology; HIV Reverse Transcriptase - antagonists & inhibitors; HIV Reverse Transcriptase - genetics; HIV-1 - drug effects; HIV-1 - enzymology; HIV-1 - genetics; HIV/AIDS; Human viral diseases; Humans; Infectious diseases; Interprofessional Relations; Male; Medical practice; Medical sciences; Mutation; Pharmacology. Drug treatments; Prospective Studies; Recommendations; Research Design; Retrospective Studies; Reverse Transcriptase Inhibitors - therapeutic use; RNA; RNA, Viral - blood; RNA, Viral - genetics; Treatment Failure; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral Load; Virology
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/377266

The Havana trial, a randomized, prospective study, demonstrated that expert interpretation of genotypic resistance test (GRT) results improved virological outcomes in human immunodeficiency virus type 1 (HIV-1)-infected patients for whom highly active antiretroviral therapy (HAART) was failing. The impact of expert advice in routine clinical practice is unknown. We retrospectively evaluated the virological outcomes of 74 patients for whom HAART was failing and whose clinical providers accepted or rejected HAART regimens recommended by an expert panel who routinely reviewed GRT results. Fifty (68%) of 74 patients received regimens recommended by the expert panel ("advice accepted" [AA]), and 24 patients (32%) received regimens per the clinician's preference ("advice rejected" [AR]). After 24 weeks, AA and AR groups had median decreases in the plasma HIV-1 RNA viral load of 2.6 and 1.3 log10 copies/mL, respectively (P = .0001). Twenty-six (52%) of 50 patients in the AA group and 5 (21%) of 24 patients in the AR group had a plasma HIV-1 RNA viral load of