Antiretroviral drug resistance testing in adult HIV-1 infection - Recommendations of an International AIDS Society-USA panel

Objective Assays for drug resistance testing in human immunodeficiency viru s type 1 (HIV-1) infection are now available and clinical studies suggest t hat viral drug resistance is correlated with poor virologic response to new therapy. The International AIDS Society-USA sought to update prior recomme ndations to provide guidance for clinicians regarding indications for HIV-1 resistance testing. Participants An International AIDS Society-USA 13-member physician panel wi th expertise in basic science, clinical research, and patient care involvin g HIV resistance to antiretroviral drugs was reconvened to provide recommen dations for the clinical use of drug resistance testing. Evidence and Consensus Process The full panel met regularly between January and October 1999. Resistance and resistance testing data appearing in the last decade th rough April 2000 and presentations at national and internati onal research conferences were reviewed. Recommendations and considerations were developed by 100% group consensus, acknowledging that definitive data to support final recommendations are not yet available. Conclusions Emerging data indicate that despite limitations, resistance tes ting should be incorporated into patient management in some settings. Resis tance testing is recommended to help guide the choice of new regimens after treatment failure and for guiding therapy for pregnant women. It should be considered in treatment-naive patients with established infection, but can not be firmly recommended in this setting. Testing also should be considere d prior to initiating therapy in patients with acute HIV infection, althoug h therapy should not be delayed pending the results. Expert interpretation is recommended given the complexity of results and assay limitations.