584-T. Meta-Analysis of Antiretroviral Drug Resistance Testing in HIV-1 Infection

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Session 77 Poster Session
Resistance Testing in Drug Selection
Session Time: 4:30-6:30 pm
Room 4E-F

584-T.

Meta-Analysis of Antiretroviral Drug Resistance Testing in HIV-1 Infection
D. Torre* and R. Tambini
Regional Hosp. and Macchi Fndn., Varese, Italy

Background: HIV-1 resistance tests, both phenotype and genotype, have been entering clinical practice during the last years, but limited prospective studies have been reported in antiretroviral-treated patients with virological failure.
Methods: A meta-analysis of randomized controlled trials (RCT) published or presented at the most important conferences until September 2001 was performed, to estimate impact of resistance-guided antiretroviral therapy on virological outcome. Search for RCT was performed by using a Medline database, Internet sources, and international conference presentations, and updated September 2001. All RCT available, including 4 RCT on genotype resistance testing, 1 RCT on phenotype resistance testing, and 1 RCT on genotypic and phenotypic testing were analyzed. The rate of patients with undetectable viremia at 3 months was reported in all RCT, and in 4 of 6 RCT at 6 months.
Results: The rate of patients with undetectable viral load after 3 months was 42.6% in patients treated based on genotype results, and 33.2% in patients treated based on standard of care (SOC) (OR 1.7; 95% CI: 1.3-2.2). At 6 months undetectable viremia was observed in 38.8% and in 28.7% of the patients, respectively (OR: 1.6; 95% CI 1.2-2.2). In 142 patients expert advice was provided to optimize clinical use of genotypic data. The higher rate of viral suppression was achieved in this subgroup of patients (50.7% vs SOC 35.8%; OR 2.4; 95% CI 1.5-3.7). In contrast, undetectable viremia was achieved in 37.5% patients treated based on phenotype results vs 33.8% patients treated based on SOC (OR 1.1; 95% CI 0.8-1.6).
Conclusions: These results support the use of genotypic test in patients experiencing virological failure during antiretroviral treatment, and expert interpretation of the test may increase the probability of virological response.

Š2002 9^th Conference on Retroviruses and Opportunistic Infections