Drug Resistance Testing: Time to be Used in Clinical Practice?

The objective of this study is to review the clinical utility of drug resistance testing for management of antiretroviral therapy in HIV-1 infection.Published reports in English of original research and meeting abstracts have been consulted. As a result, technological advances have led to improved assays for phenotyping and genotyping HIV-1 directly from plasma samples, making it feasible to perform drug resistance testing in real time. A correlation between emergence of drug resistance and virologic failure can be demonstrated for most antiretroviral agents. Preliminary results from retrospective studies suggest that drug resistance testing can identify which patients are likely to respond to particular treatment regimens.We can conclude that drug resistance testing may be useful in guiding the choice of initial antiretroviral therapy, explaining and managing treatment failure, and tracking the transmission of drug-resistant isolates. Ongoing clinical trials will help to determine whether a treatment strategy that incorporates results of resistance testing leads to improved clinical outcome. Uniform criteria for interpretation and quality control are needed in order to standardize assay results across the various methods being applied. Despite these concerns, resistance testing will become a valuable tool in the clinical management of HIV-1 infection.