Abstract
BackgroundReplicative phenotypic HIV resistance testing (rPRT) uses recombinant infectious virus to measure viral replication in the presence of antiretroviral drugs. Due to its high sensitivity of detection of viral minorities and its dissecting power for complex viral resistance patterns and mixed virus populations rPRT might help to improve HIV resistance diagnostics, particularly for patients with multiple drug failures. The aim was to investigate whether the addition of rPRT to genotypic resistance testing (GRT) compared to GRT alone is beneficial for obtaining a virological response in heavily pre-treated HIV-infected patients.MethodsPatients with resistance tests between 2002 and 2006 were followed within the Swiss HIV Cohort Study (SHCS). We assessed patients' virological success after their antiretroviral therapy was switched following resistance testing. Multilevel logistic regression models with SHCS centre as a random effect were used to investigate the association between the type of resistance test and virological response (HIV-1 RNA <50 copies/mL or ≥1.5log reduction).ResultsOf 1158 individuals with resistance tests 221 with GRT+rPRT and 937 with GRT were eligible for analysis. Overall virological response rates were 85.1% for GRT+rPRT and 81.4% for GRT. In the subgroup of patients with >2 previous failures, the odds ratio (OR) for virological response of GRT+rPRT compared to GRT was 1.45 (95% CI 1.00-2.09). Multivariate analyses indicate a significant improvement with GRT+rPRT compared to GRT alone (OR 1.68, 95% CI 1.31-2.15).ConclusionsIn heavily pre-treated patients rPRT-based resistance information adds benefit, contributing to a higher rate of treatment success.
Highlights
Replicative phenotypic HIV resistance testing uses recombinant infectious virus to measure viral replication in the presence of antiretroviral drugs
Individuals who had a prospective resistance test performed between 2002 and 2006 for which the physician had access to results prior to making clinical decisions were eligible for the study if the following criteria were fulfilled; (i) Combination antiretroviral therapy (cART) was changed within one year after a resistance test was performed, (ii) the patient was off treatment for
We explored whether Replicative phenotypic HIV resistance testing (rPRT) in addition to genotypic resistance testing (GRT) was associated with higher rates of virological response
Summary
Replicative phenotypic HIV resistance testing (rPRT) uses recombinant infectious virus to measure viral replication in the presence of antiretroviral drugs. Due to its high sensitivity of detection of viral minorities and its dissecting power for complex viral resistance patterns and mixed virus populations rPRT might help to improve HIV resistance diagnostics, for patients with multiple drug failures. The aim was to investigate whether the addition of rPRT to genotypic resistance testing (GRT) compared to GRT alone is beneficial for obtaining a virological response in heavily pre-treated HIV-infected patients. GRT is based on population gene sequencing of defined DNA segments, typically to detect mutations, which represent at least 20% of the virus population and confer HIV-1 drug resistance [10,11].
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