Interpreting Resistance Data for HIV-1 Therapy Management – Know the Limitations
Kristel van Laethem 1, Anne-Mieke Vandamme 1
1 NULL
*Correspondence: Anne-Mieke Vandamme, Email not available
Abstract
Antiviral drug resistance can be one of the causes for HIV-1 therapy failure. Several studies haveshown some beneficial effect of antiviral resistance testing on response to the following therapyregimen. The technical performances of genotypic and phenotypic assays have been considerablyimproved with time. However, both are still limited in their power to fully map antiviral resistance ascause of therapy failure. Nevertheless, the results of genotypic and phenotypic assays can oftendeliver complementary information. The greatest challenge still remains in the accurate interpretationof in vitro resistance results, whether genotypic or phenotypic, into information that can be implementedinto clinical practice. For phenotypic assays, bioinformatics analyses linking fold-resistancevalues and clinical response data have been performed, or are currently ongoing, to assign clinicalcut-offs for all drugs. Genotypic drug-resistance interpretation systems have been developed andare continuously being updated to solve the same problem. Retrospective and prospective studieshave compared systems in their performance to predict phenotype or in their ability to predicttherapy outcome. All these analysis are of value, but still display some weak points. However, dueto the fast evolving know-how in the field, a prospective trial in which different systems are comparedhead-to-head will be difficult to design.
