|
Updated
European Recommendations for the Clinical Use of HIV Drug Resistance
Testing
In most European countries, HIV drug resistance
testing has become a routine clinical tool. However, its practical
implementation in a clinical context is demanding. The European
HIV Drug Resistance Panel was established to make recommendations
to clinicians and virologists on this topic and to propose quality
control measures.
The panel recommends resistance testing for
the following indications:
Drug-naive patients with acute or recent infection;
Therapy
failure, including suboptimal treatment response,
when treatment change is considered;
Pregnant HIV-1-infected women and pediatric
patients with detectable viral load when treatment
initiation or change is considered; and
Genotype source
patient when post-exposure
prophylaxis is considered.
In
addition, for drug-naive patients with chronic infection in whom
treatment is to be started, the panel suggests that resistance
testing should be strongly considered and recommends testing
the earliest sample for drug resistance if suspicion of resistance
is high or prevalence of resistance in this population exceeds 10%.
The
panel does not favor genotyping
over phenotype,
however it is anticipated that genotyping will be used more often
because of its greater accessibility, lower cost and faster turnaround
time.
For
the interpretation of resistance data, clinically validated systems
should be used to the greatest extent possible. It is mandatory
that laboratories performing HIV resistance tests take regular part
in quality assurance programs.
Similarly,
it is necessary that HIV clinicians and virologists take part in
continuous education and meet regularly to discuss problematic clinical
cases. Indeed, resistance test results should be used in the context
of all other clinically relevant information for predicting therapy
response.
The
panel also encourages the timely collection of epidemiological information
to estimate the impact of transmission of resistant HIV and the
prevalence of HIV-1 non-B subtypes in the different European countries.
01/28/05
Reference
A-M
Vandamme and others. Updated European recommendations for the clinical
use of HIV drug resistance testing. Antiviral Therapy 2004;
9(6): 829–848. December 2004.
|
