Resistance testing should guide initial HIV treatment choice

A substantial portion of antiretroviral-naive patients are infected with transmitted drug-resistant HIV with 1 or more drug-resistant mutations, and they are much more likely to experience treatment failure, said Linda Wittkop, MD, of the University Bordeaux, Segalen, France, and colleagues participating in a European multicohort study published in TheLancet Infectious Disease.

The researchers studied 10,056 patients who were receiving combination antiretroviral therapy (cART) and who had undergone genotypic testing for drug-resistant mutation.  The goal was to determine the effect of transmitted drug resistance (TDR) on cART.

Of the 10,056 patients, 475 (4.7%), had at least 1 mutation, but received fully active cART; 479 (4.8%) had at least 1 mutation and resistance to at least 1 drug. The other 9,102 patients had HIV without TDR. Estimates of virological failure at 12 months were 4.2% for patients in the non-TDR group; 4.7% for those in the TDR and fully-active cART group; and 15.1% for those in the TDR and resistant group.

"These findings confirm present treatment guidelines for HIV, which state that the initial treatment choice should be based on resistance testing in treatment-naive patients," the authors concluded.