The impact of HIV drug resistance testing on changes to treatment

TitleThe impact of HIV drug resistance testing on changes to treatment
Publication TypeJournal Article
Year of Publication2011
AuthorsBansi L, Smith C, Phillips AN, Kirk S., Geretti AM, Johnson M, Mackie N, Post FA, Gazzard B, Dunn DT, Sabin CA
JournalAIDS
Volume25
Pagination603-10
Date PublishedMar 13
ISBN Number0269-9370
Accession Number21297420
Keywords*Drug Resistance, Viral/drug effects/genetics, *Retreatment, Adult, Anti-Retroviral Agents/*administration & dosage, Data Collection, Drug Administration Schedule, Female, Genotype, HIV Infections/drug therapy/*genetics/virology, HIV-1/*drug effects/genetics, Humans, Male, Microbial Sensitivity Tests, Treatment Outcome, Viral Load
Abstract

BACKGROUND: We investigate changes made to therapy after a resistance test result and identify factors associated with switching regimen. METHODS: Patients receiving antiretroviral therapy (ART) who had a resistance test performed during 1998-2007 were included in the analysis. A switch was defined as starting at least two drugs/starting a drug from a class not previously experienced within 4 months of the resistance test result. Logistic regression was used to identify factors independently associated with switching regimen. RESULTS: Of the 5123 test results included in the analyses, 1874 (36.6%) were followed by a switch within 4 months of the test result. Independent factors associated with switching included genotypic sensitivity score (GSS) of the current regimen [odds ratio (OR) 4.86, 95% confidence interval (CI) 3.95, 5.97 for GSS less than 1 compared to GSS of at least 3] and a higher number of previous failures [1.12 (1.06, 1.18) per additional failed regimen]. Patients with fewer drug options were less likely to switch [0.36 (0.27, 0.48) comparing 0-3 drug options with >/=10 drug options]. CONCLUSIONS: Only 37% of patients switched regimen within 4 months of the resistance test result. Whilst toxicity concerns of available drugs may somewhat explain this finding, it is also likely that there is a lack of treatment options available for patients who did not switch.

Short TitleAIDS (London, England)
Alternate JournalAIDS (London, England)