How Does Expert Advice Impact Genotypic Resistance Testing in Clinical Practice?

Badri, Sheila M.; Adeyemi, Oluwatoyin M.; Max, Blake E.; Zagorski, Brandon M.; Barker, David E.
September 2003
Clinical Infectious Diseases;9/1/2003, Vol. 37 Issue 5, p708
Academic Journal
The Havana trial, a randomized, prospective study, demonstrated that expert interpretation of genotypic resistance test (GRT) results improved virological outcomes in human immunodeficiency virus type 1 (HIV-1)-infected patients for whom highly active antiretroviral therapy (HAART) was failing. The impact of expert advice in routine clinical practice is unknown. We retrospectively evaluated the virological outcomes of 74 patients for whom HAART was failing and whose clinical providers accepted or rejected HAART regimens recommended by an expert panel who routinely reviewed GRT results. Fifty (68%) of 74 patients received regimens recommended by the expert panel ("advice accepted" [AA]), and 24 patients (32%) received regimens per the clinician's preference ("advice rejected" [AR]). After 24 weeks, AA and AR groups had median decreases in the plasma HIV-1 RNA viral load of 2.6 and 1.3 log[SUB10] copies/mL, respectively (P=.0001). Twenty-six (52%) of 50 patients in the AA group and 5 (21%) of 24 patients in the AR group had a plasma HIV-1 RNA viral load of <50 copies/mL (P=.01). Consideration should be given to enlisting expert assistance in the inter-pretation of GRT results in routine clinical practice.


Related Articles

  • Human Immunodeficiency Virus Type 1 Quasi Species That Rebound after Discontinuation of Highly Active Antiretroviral Therapy Are Similar to the Viral Quasi Species Present before Initiation of Therapy. Imamichi, Hiromi; Crandall, Keith A.; Natarajan, Ven; Jiang, Min Kang; Dewar, Robin L.; Berg, Steve; Gaddam, Arunasri; Bosche, Marjorie; Metcalf, Julia A.; Davey Jr., Richard T.; Lane, H. Clifford // Journal of Infectious Diseases;1/1/2001, Vol. 183 Issue 1, p36 

    Presents a study which conducted an HIV quasi species analysis for patients with HIV RNA to identify the source of the viruses that emerge after discontinuation of therapy. Methods; Results; Discussion.

  • Determining the Effect of Highly Active Antiretroviral Therapy on Changes in Human Immunodeficiency Virus Type 1 RNA Viral Load using a Marginal Structural Left-censored Mean Model. Stephen R. Cole; Miguel A. Hernán; Kathryn Anastos; Beth D. Jamieson; James M. Robins // American Journal of Epidemiology;Jun2007, Vol. 166 Issue 2, p219 

    Highly active antiretroviral therapy (HAART) dramatically reduces the load of circulating human immunodeficiency virus type 1 (HIV-1) by blocking replication at multiple points in the viral life cycle, but the long-term effect of HAART on viral load remains unclear. In the Multicenter AIDS...

  • HIV-1 nef suppression by virally encoded microRNA. Omoto, Shinya; Ito, Masafumi; Tsutsumi, Yutaka; Ichikawa, Yuko; Okuyama, Harumi; Brisibe, Ebiamadon Andi; Saksena, Nitin K.; Fujii, Yoichi R. // Retrovirology;2004, Vol. 1, p44 

    Background: MicroRNAs (miRNAs) are 21~25-nucleotides (nt) long and interact with mRNAs to trigger either translational repression or RNA cleavage through RNA interference (RNAi), depending on the degree of complementarity with the target mRNAs. Our recent study has shown that HIV-1 nef dsRNA...

  • Association of Medical Insurance and Other Factors With Receipt of Antiretroviral Therapy. Keruly, Jeanne C.; Conviser, Richard; Moore, Richard D. // American Journal of Public Health;May2002, Vol. 92 Issue 5, p852 

    Objectives. This study was designed to assess sociodemographic and medical insurer factors associated with receipt of highly active antiretroviral therapy (HAART). Methods. Patients included (n = 959) were enrolled in the Johns Hopkins HIV Clinic after April 1,1996, received ≥90 days of...

  • DISSECTING HIV-1 THROUGH RNA INTERFERENCE. Stevenson, Mario // Nature Reviews Immunology;Nov2003, Vol. 3 Issue 11, p851 

    Presents information on the dissection of HIV-1 through RNA interference (RNAi). Mechanism of RNAi; Modulation of HIV-1 replication by RNAi; Discussion on cellular HIV-1 co-factors as targets for RNAi.

  • Testing for Plasma HIV RNA Levels and CD4[sup+] T Cell Count To Guide Decisions Regarding Therapy.  // MMWR: Morbidity & Mortality Weekly Report;5/17/2002 Supplement RR-7, Vol. 51 Issue 19, p2 

    Presents a study on the use of testing for plasma HIV ribonucleic acid levels and CD4 T cell count. Function of HIV viral load testing; Factors that affect the rates of viral load decline toward undetectable; Informative factors for decision-making regarding antiretroviral therapy.

  • Plasma Human Immunodeficiency Virus RNA Below 40 Copies/mL Is Rare in Untreated Persons Even in the First Years of Infection. Lefrere, Jean-Jacques; Mariotti, Martine; Morand-Joubert, Laurence; Thauvin, Micheline; Roudot-Thoraval, Francoise // Journal of Infectious Diseases;8/1/99, Vol. 180 Issue 2 

    Examines the frequency and prognostic significance of HIV RNA virus in untreated patients in the first year of infection. Replication of HIV in the lymphoid tissue during symptomless carriage period; Use of ultrasensitive assay to identify persons with low virus loads; Trend in the disease...

  • Early Intervention in Schizophrenia. Clarke, Mary // Current Medical Literature: Psychiatry;2004, Vol. 15 Issue 4, p85 

    Provides information on the controversies and concerns associated with the concept of early intervention in schizophrenia. Factors that influence the outcome of patients with the disorder; Median values of the duration of untreated psychosis (DUP) reported from studies; Explanation on the...

  • New food program helps people with HIV. Hemmelgarn, Seth // Bay Area Reporter;10/10/2013, Vol. 43 Issue 41, p2 

    The article reports on the HIV+ Grocery project, which is a new program in San Francisco, California aimed at helping people with HIV infection and require help to get food but wish to cook food by them.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics