Author Affiliations: Harvard Medical School, Boston, Mass (Drs Hirsch and D'Aquila); Hôpital Bichat-Claude Bernard, Paris, France (Dr Brun-Vézinet); Columbia University College of Physicians and Surgeons, New York, NY (Dr Hammer); University of Alabama at Birmingham School of Medicine and Birmingham Veterans Affairs Medical Center (Dr Johnson); University of Colorado Health Sciences Center, Denver (Dr Kuritzkes); The Royal Free Hospital Medical School, London, England (Dr Loveday); University of Pittsburgh and Veterans Affairs Medical Center, Pittsburgh, Pa (Dr Mellors); Fundacio irsaCAIXA and HIV Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (Dr Clotet); Viridae Clinical Sciences and University of British Columbia, Vancouver (Dr Conway); University of Rochester, Rochester, NY (Dr Demeter); Istituto Superiore di Sanità, Rome, Italy (Dr Vella); International AIDS Society–USA, San Francisco, Calif (Ms Jacobsen); and University of California, San Diego, and San Diego Veterans Affairs Medical Center (Dr Richman).
Objective Assays for drug resistance testing in human immunodeficiency virus type
1 (HIV-1) infection are now available and clinical studies suggest that viral
drug resistance is correlated with poor virologic response to new therapy.
The International AIDS Society–USA sought to update prior recommendations
to provide guidance for clinicians regarding indications for HIV-1 resistance
Participants An International AIDS Society–USA 13-member physician panel with
expertise in basic science, clinical research, and patient care involving
HIV resistance to antiretroviral drugs was reconvened to provide recommendations
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 through April 2000
and presentations at national and international 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 testing
should be incorporated into patient management in some settings. Resistance
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 cannot be firmly
recommended in this setting. Testing also should be considered prior to initiating
therapy in patients with acute HIV infection, although therapy should not
be delayed pending the results. Expert interpretation is recommended given
the complexity of results and assay limitations.
Hirsch MS, Brun-Vézinet F, D'Aquila RT, Hammer SM, Johnson VA, Kuritzkes DR, Loveday C, Mellors JW, Clotet B, Conway B, Demeter LM, Vella S, Jacobsen DM, Richman DD. Antiretroviral Drug Resistance Testing in Adult HIV-1 InfectionRecommendations of an International AIDS Society–USA Panel. JAMA. 2000;283(18):2417-2426. doi:10.1001/jama.283.18.2417