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To the Editor: The usefulness of genotype resistance testing in the clinical management of HIV infection is increasingly clear. However, as Dr Hirsch and colleagues¹ state, several technical issues concerning standardization and clinical validation have yet to be resolved.

Although genotypic assays are increasingly common in the clinical setting, interpretation of results is more complex than merely identifying mutations and then eliminating antiretroviral drugs that supposedly are not efficacious. In fact, the same combinations of primary and secondary mutations may result from several different scenarios.

Genotypic testing shows the mutational pattern detected in the amplicon. This does not necessarily correspond to a single viral clone because the same pattern may result from the superimposition of the genotypes from different clones. It may be quite misleading to assume that all mutations belong to the same clone, as is often done in a more conservative therapeutical approach. On the other hand, given . . . [Full Text of this Article]

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