TY - JOUR
TI - Effectiveness of Transmitted Drug Resistance Testing before Initiation of Antiretroviral Therapy in HIV-Positive Individuals
AU - Lodi, S.
AU - Günthard, H.F.
AU - Gill, J.
AU - Phillips, A.N.
AU - Dunn, D.
AU - Vu, Q.
AU - Siemieniuk, R.
AU - Garcia, F.
AU - Logan, R.
AU - Jose, S.
AU - Bucher, H.C.
AU - Scherrer, A.U.
AU - Reiss, P.
AU - Van Sighem, A.
AU - Boender, T.S.
AU - Porter, K.
AU - Gilson, R.
AU - Paraskevis, D.
AU - Simeon, M.
AU - Vourli, G.
AU - Moreno, S.
AU - Jarrin, I.
AU - Sabin, C.
AU - Hernán, M.A.
JO - JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
PY - 2019
VL - 82
TODO - 3
SP - 314-320
PB - Lippincott Williams and Wilkins
SN - null
TODO - 10.1097/QAI.0000000000002135
TODO - efavirenz;  nevirapine;  nonnucleoside reverse transcriptase inhibitor;  RNA directed DNA polymerase inhibitor;  stavudine;  anti human immunodeficiency virus agent;  antiretrovirus agent, acquired immune deficiency syndrome;  adult;  antiretroviral therapy;  Article;  CD4 lymphocyte count;  clinical outcome;  clinical practice;  cohort analysis;  female;  human;  Human immunodeficiency virus infected patient;  Human immunodeficiency virus infection;  major clinical study;  male;  nonparametric test;  prevalence;  priority journal;  RNA virus;  sensitivity analysis;  transmitted drug resistance;  antiviral resistance;  combination drug therapy;  drug effect;  Human immunodeficiency virus 1;  Human immunodeficiency virus infection;  middle aged;  virology, Adult;  Anti-HIV Agents;  Anti-Retroviral Agents;  CD4 Lymphocyte Count;  Drug Resistance, Viral;  Drug Therapy, Combination;  Female;  HIV Infections;  HIV-1;  Humans;  Male;  Middle Aged
TODO - Background:For people living with HIV, major guidelines in high-income countries recommend testing for transmitted drug resistance (TDR) to guide the choice of first-line antiretroviral therapy (ART). However, individuals who fail a first-line regimen can now be switched to one of several effective regimens. Therefore, the virological and clinical benefit of TDR testing needs to be evaluated.Methods:We included individuals from the HIV-CAUSAL Collaboration who enrolled <6 months of HIV diagnosis between 2006 and 2015, were ART-naive, and had measured CD4 count and HIV-RNA. Follow-up started at the date when all inclusion criteria were first met (baseline). We compared 2 strategies: (1) TDR testing within 3 months of baseline versus (2) no TDR testing. We used inverse probability weighting to estimate the 5-year proportion and hazard ratios (HRs) of virological suppression (confirmed HIV-RNA <50 copies/mL), and of AIDS or death under both strategies.Results:Of 25,672 eligible individuals (82% males, 52% diagnosed in 2010 or later), 17,189 (67%) were tested for TDR within 3 months of baseline. Of these, 6% had intermediate- or high-level TDR to any antiretroviral drug. The estimated 5-year proportion virologically suppressed was 77% under TDR testing and 74% under no TDR testing; HR 1.06 (95% confidence interval: 1.03 to 1.19). The estimated 5-year risk of AIDS or death was 6% under both strategies; HR 1.03 (95% confidence interval: 0.95 to 1.12).Conclusions:TDR prevalence was low. Although TDR testing improved virological response, we found no evidence that it reduced the incidence of AIDS or death in first 5 years after diagnosis. © 2019 Wolters Kluwer Health, Inc. All rights reserved.
ER -