Management of therapeutic escape in HIV-infected patients

A common situation: Among HIV-infected patients treated with antiretroviral regimens, 20% to 50% escape therapeutic control. The principal factors ton predictive of treatment failure are low CD4 counts and high viral load pri or to institution of the antiretroviral treatment. Several virological and pharmacological mechanisms are implicated. II Genotyping and phenotyping: Genotyping is particularly useful to optimize t reatment in HIV-infected patients who escape therapeutic control, irrespect ive of the therapeutic strategy. A committee of experts has developed a sch eme for adapting treatment to the very complex results of genotyping tests. The benefit of phenotyping remains to be established. Management: Serum concentrations of antiretioviral agents should be determi ned and adapted in order to maximize the treatment effect, However, to mana ge therapeutic escape, the only method with a proven impact is genotyping. The possible usefulness of regular drug assays for adjusting treatment dose s in case of therapeutic escape remains to be assessed in prospective trial s. (C) 2001, Masson, Paris.