A randomized study of antiretroviral management based on plasma genotypic antiretroviral resistance testing in patients failing therapy

Baxter, John D.; Mayers, Douglas L.; Wentworth, Deborah; Neaton, James D.; Hoover, Marie L.; Winters, Mark A.; Mannheimer, Sharon; Thompson, Melanie; Abrams, Donald I.; Brizz, Barbara; Ioannidis, John P. A.; Merigan, Thomas C.

doi:10.1097/00002030-200006160-00001

Cited by 476 publications

(315 citation statements)

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“…First, it does not prove that HIV-1 resistance testing will improve clinical outcomes in patients who are experiencing less-than-optimal virologic suppression with antiretroviral therapy, thus warranting a change in therapy according to current guidelines (48,49). However, two recent pilot studies comparing HIV-1 genotype-guided choice with standard practice choice of new antiretroviral agents for patients in whom therapy is failing suggested improved virologic outcomes with genotypic guidance (50,51). Second, the size of our study did not allow for detailed analysis of drug history in all its complexity, nor could we analyze all possible combinations of mutations that might affect outcome.…”

Section: Discussionmentioning

confidence: 99%

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HIV-1 Genotypic Resistance Patterns Predict Response to saquinavir–ritonavir Therapy in Patients in Whom Previous Protease Inhibitor Therapy Had Failed

et al. 1999

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Section: Discussionmentioning

confidence: 99%

“…In randomized, controlled pilot trials (50,51), this prognostic capacity may translate into improved treatment outcomes of HIV-1 infected persons, but further study is required.…”

Section: Discussionmentioning

confidence: 99%

HIV-1 Genotypic Resistance Patterns Predict Response to saquinavir–ritonavir Therapy in Patients in Whom Previous Protease Inhibitor Therapy Had Failed

et al. 1999

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“…Genotypic HIV-1 drug resistance was tested with home-brew HIV-1 genotypic drug resistance methods [10,11]. All the samples were assayed with the following algorithm: amplification of HIV-1 pol gene fragment, sequencing directly, identification of mutations related with drug resistance, analyze the mutation, explanation of drug resistance.…”

Section: Testing Of Drug Resistancementioning

confidence: 99%

Prevalence and evolution of drug resistance HIV-1 variants in Henan, China

et al. 2005

Cell Res

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ABSTACTTo understand the prevalence and evolution of drug resistant HIV strains in Henan China after the implementation of free antiretroviral therapy for AIDS patients. 45 drug naïve AIDS patients, 118 AIDS patients who received three months antiretroviral therapy and 124 AIDS patients who received six months antiretroviral treatment were recruited in the southern part of Henan province. Information on general condition, antiretroviral medicines, adherence and clinical syndromes were collected by face to face interview. Meanwhile, 14ml EDTA anticoagulant blood was drawn. CD4/CD8 T cell count, viral load and genotypic drug resistance were tested. The rates of clinical improvement were 55.1% and 50.8% respectively three months and six months after antiretroviral therapy. The mean CD4 cell count after antiretroviral therapy was significantly higher than in drug naïve patients. The prevalence rate of drug resistant HIV strains were 13. 9%, 45.4% and 62.7% in drug naïve patients, three month treatment patients and six month treatment patients, respectively. The number of resistance mutation codons and the frequency of mutations increased significantly with continued antiretroviral therapy. The mutation sites were primarily at the 103, 106 and 215 codons in the three-month treatment group and they increased to 15 codon mutations in the six-month treatment group. From this result, the evolution of drug resistant strains was inferred to begin with the high level NNRTI resistant strain, and then develop low level resistant strains to NRTIs. The HIV strains with high level resistance to NVP and low level resistance to AZT and DDI were highly prevalent because of the AZT+DDI+NVP combination therapy. These HIV strains were also cross resistant to DLV, EFV, DDC and D4T. Poor adherence to therapy was believed to be the main reason for the emergence and prevalence of drug resistant HIV strains. The prevalence of drug resistant HIV strains was increased with the continuation of antiretroviral therapy in the southern part of Henan province. Measures, that could promote high level adherence, provide new drugs and change ART regimens in failing patients, should be implemented as soon as possible.

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“…Les études cliniques VIRADAPT et CPCRA 046 (GART) ont contribué à valider ce test [37,38]. La décision clinique consécutive à un test de génotypage est souvent prise après analyse d'algorithmes (conçus pour interpréter les résultats de ces tests) ou d'opinions d'experts qui peuvent présen-ter certaines discordances [39].…”

Section: Test De Génotypage: Valeur Pronostique Et Utilisation Rationunclassified

Résistance du VIH aux antirétroviraux

et al. 2004

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A randomized study of antiretroviral management based on plasma genotypic antiretroviral resistance testing in patients failing therapy

Abstract: In patients failing triple drug therapy, GART with expert advice was superior to no-GART as measured by short-term viral load responses.

Cited by 476 publications

References 18 publications

HIV-1 Genotypic Resistance Patterns Predict Response to saquinavir–ritonavir Therapy in Patients in Whom Previous Protease Inhibitor Therapy Had Failed

HIV-1 Genotypic Resistance Patterns Predict Response to saquinavir–ritonavir Therapy in Patients in Whom Previous Protease Inhibitor Therapy Had Failed

Prevalence and evolution of drug resistance HIV-1 variants in Henan, China

Résistance du VIH aux antirétroviraux

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