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May 10, 2000

HIV Genotype and Phenotype—Arresting Resistance?

Author Affiliations

Author Affiliation: Divisions of Clinical Pharmacology and Infectious Diseases, Departments of Medicine and Pharmacology and Molecular Sciences, The Johns Hopkins University School of Medicine, Baltimore, Md.

JAMA. 2000;283(18):2442-2444. doi:10.1001/jama.283.18.2442

Fourteen antiretroviral drugs are now Food and Drug Administration (FDA)–approved for the treatment of human immunodeficiency virus (HIV) infection. Patients must take combination therapy perpetually because rapid virus turnover and high mutation rates promote drug resistance. The increasing prevalence of resistance has prompted development of drug resistance assays, and high-throughput techniques are now commercially available.

This issue of THE JOURNAL contains recommendations, developed by an international panel of experts, for the use and interpretation of anti-HIV drug resistance assays.1 Two major analytic approaches are discussed: genotypic assays that identify particular mutations, usually point mutations, associated with resistance; and phenotypic assays that measure the ability of the patient's virus to grow in the presence of known concentrations of anti-HIV drugs. Although these techniques are scientifically sophisticated and exciting, they present dilemmas for the clinician and patient.

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