Antiretroviral resistance testing may be of limited clinical benefit

NEW YORK (Reuters Health) - Despite widespread recommendations supporting its use, antiretroviral resistance testing is of limited value in the clinical management of treatment-experienced, HIV-infected patients, according to a report in the November 5th issue of AIDS.

"Guidelines should temper their enthusiasm about antiretroviral resistance testing," Dr. John P. A. Ioannidis, of the University of Ioannina School of Medicine in Greece, told Reuters Health.

Dr. Ioannidis and colleagues conducted a meta-analysis of 10 relevant randomized, controlled trials to determine the magnitude of the impact of antiretroviral resistance testing (ART) on various HIV outcome measures.

Genotypic ART-guided treatment was associated with a statistically significantly higher proportion of patients with viral load below detection at 3 and 6 months, the authors report, but there was no association with increases in CD4 cell counts.

Phenotypic ART-guided treatment was not associated with any statistical difference in virologic or immunological responses at 3 or 6 months, the report indicates.

Virtual phenotypic ART-guided treatment showed a trend in favor of improved immunological outcomes, the researchers note, but it was not significantly better than empiric therapy in virologic outcomes.

"The meta-analysis covered treatment-experienced patients, and the benefit seems to be limited in all subgroup analyses without any major subgroup differences," Dr. Ioannidis said. "While small benefits are possible, they may not be that great in routine clinical practice."

Physicians should "consider antiretroviral resistance testing for treatment-experienced patients on an individual basis, taking the whole picture of the patient into account," Dr. Ioannidis concluded.

Source: AIDS 2004;18:2153-2161. [ Google search on this article ]

MeSH Headings: Anti-HIV Agents