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Recommendations of an International AIDS Society–USA Panel

Martin S. Hirsch, MD; Françoise Brun-Vézinet, MD; Richard T. D'Aquila, MD; Scott M. Hammer, MD; Victoria A. Johnson, MD; Daniel R. Kuritzkes, MD; Clive Loveday, MD, PhD; John W. Mellors, MD; Bonaventura Clotet, MD, PhD; Brian Conway, MD; Lisa M. Demeter, MD; Stefano Vella, MD; Donna M. Jacobsen; Douglas D. Richman, MD

JAMA. 2000;283:2417-2426.

Objective  Assays for drug resistance testing in human immunodeficiency virus type 1 (HIV-1) infection are now available and clinical studies suggest that viral drug resistance is correlated with poor virologic response to new therapy. The International AIDS Society–USA sought to update prior recommendations to provide guidance for clinicians regarding indications for HIV-1 resistance testing.

Participants  An International AIDS Society–USA 13-member physician panel with expertise in basic science, clinical research, and patient care involving HIV resistance to antiretroviral drugs was reconvened to provide recommendations for the clinical use of drug resistance testing.

Evidence and Consensus Process  The full panel met regularly between January and October 1999. Resistance and resistance testing data appearing in the last decade through April 2000 and presentations at national and international research conferences were reviewed. Recommendations and considerations were developed by 100% group consensus, acknowledging that definitive data to support final recommendations are not yet available.

Conclusions  Emerging data indicate that despite limitations, resistance testing should be incorporated into patient management in some settings. Resistance testing is recommended to help guide the choice of new regimens after treatment failure and for guiding therapy for pregnant women. It should be considered in treatment-naive patients with established infection, but cannot be firmly recommended in this setting. Testing also should be considered prior to initiating therapy in patients with acute HIV infection, although therapy should not be delayed pending the results. Expert interpretation is recommended given the complexity of results and assay limitations.

Author Affiliations: Harvard Medical School, Boston, Mass (Drs Hirsch and D'Aquila); Hôpital Bichat-Claude Bernard, Paris, France (Dr Brun-Vézinet); Columbia University College of Physicians and Surgeons, New York, NY (Dr Hammer); University of Alabama at Birmingham School of Medicine and Birmingham Veterans Affairs Medical Center (Dr Johnson); University of Colorado Health Sciences Center, Denver (Dr Kuritzkes); The Royal Free Hospital Medical School, London, England (Dr Loveday); University of Pittsburgh and Veterans Affairs Medical Center, Pittsburgh, Pa (Dr Mellors); Fundacio irsaCAIXA and HIV Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (Dr Clotet); Viridae Clinical Sciences and University of British Columbia, Vancouver (Dr Conway); University of Rochester, Rochester, NY (Dr Demeter); Istituto Superiore di Sanità, Rome, Italy (Dr Vella); International AIDS Society–USA, San Francisco, Calif (Ms Jacobsen); and University of California, San Diego, and San Diego Veterans Affairs Medical Center (Dr Richman).

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