Tests that measure whether the strains of HIV infecting a patient are resistent to antiviral drugs may be useful in helping plan treatment strategies, but more information is needed to determine the best usage of such tests, says an international panel of AIDS experts. In a report appearing in the June 24 issue of the Journal of the American Medical Association, the panel convened by the International AIDS Society-USA outlines several implications of and recommendations regarding testing for drug resistance in HIV. The study's lead author is Martin Hirsch, MD, director of Clincal AIDS Research at the Massachusetts General Hospital and professor of Medicine at Harvard Medical School (HMS).
"It is clear that viral resistance, the existence or development of strains of HIV that can escape the effects of particular antiviral drugs, is an important reason why drug treatment fails some patients," Hirsch says. "While there is not yet enough data available to recommend which of the available tests is best in particular situations, we do believe that resistance information may be useful in guiding treatment, particularly in areas where resistant strains are prevalent."
The panel was made up of 13 physicians from six countries, experts in AIDS treatment and in research relevant to the issue of resistance. The group was convened by the International AIDS Society-USA as part of their effort to monitor and address areas of controversy in the treatment of HIV-related disease. The panel reviewed existing information from published reports, research conference presentations, basic and clinical research studies and information from the manufacturers of available resistance assays and met regularly over a six-month period to develop their report.
Among the group's conclusions are the following:
"A lot of people are doing resistance testing--and test manufacturers are advocating for their products--but we really haven't known enough about how to interpret or use the information these tests provide," Hirsch says. "This group's guidelines are a start toward better understanding of how resistance tests eventually may help us plan and implement better drug therapy regimens."
Other members of the panel are Brian Conway, MD, of St. Paul's Hospital, Vancouver; Richard D'Aquila, MD, of the MGH; Victoria Johnson, MD, of the University of Alabama at Birmingham School of Medicine; Francoise Brun Vezinet, MD, of Hopital Bichat-Claude Bernard, Paris; Bonaventura Clotet, MD, PhD, of Hospital Universitari Germans Trias i Pujol, Barcelona; Lisa Demeter, MD, University of Rochester; Scott Hammer, MD, Beth Israel Deaconess Medical Center and HMS, Boston; Donna Jacobsen, IAS-USA; Daniel Kuritzkes, MD, University of Colorado Health Sciences Center, Denver; Clive Loveday, MD, PhD, Royal Free Hospital Medical School, London; John Mellors, MD, University of Pittsburgh Medical Center; Stefano Vella, MD, Istituto Superiore di Sanita, Rome; and Douglas Richman, MD, University of California at San Diego. The panel's work was supported by the International AIDS Society-USA, San Francisco.
JAMA