APPLICATION OF AN EXPERT-SYSTEM IN THE MANAGEMENT OF HIV-INFECTED PATIENTS

A rule-based expert system, Customized Treatment Strategies for HIV (C TSHIV), which encodes information from the literature on known drug-re sistant mutations was developed. Additional rules include ranking and weighting based on antiviral activities, redundant mechanisms of actio n, overlapping toxicities, relative levels of drug-resistance, and pro portion of drug-resistant clones in the HIV quasispecies. Plasma was o btained from HIV-infected patients and the RNA was extracted. Segments of the HIV pol gene encoding the entire protease, reverse transcripta se, and integrase proteins were amplified by reverse transcriptase-pol ymerase chain reaction (using a total of three primer pairs) and clone d. Sequencing was performed on five clones from each of two patients. When the patient's RNA sequencing data were entered into the expert pr ogram, and the information was downloaded directly into the CTSHIV pro gram, the five most effective two, three, and four drug regimens coupl ed with an explanation for their choice were displayed for each patien t. Thus, the CT-SHIV system couples efficient genetic sequencing with an expert program that recommends regimens based on information in the current medical literature. It may serve as a useful tool in the desi gn of clinical trials and in the management of HIV-infected patients.