US guidelines now recommend that all HIV-positive patients have a resistance test before starting HIV therapy

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US HIV treatment guidelines have been updated to include a recommendation that all HIV-positive patients should have a genotypic resistance test before starting anti-HIV therapy.

The previous edition of the US guidelines only recommended resistance tests for patients with long-term HIV infection. However, an amendment to the Department of Health and Human Services’s Guidelines for the Use of Antiretroviral Agents in HIV-1 Infected Adults and Adolescents issued on May 4th recommends that patients with chronic HIV infection and those with acute HIV infection should have resistance tests before antiretroviral therapy is initiated.

Research suggesting that as many as 16% of patients newly diagnosed with HIV are infected with drug resistant virus prompted the change in the US guidelines, which note that using resistance tests can help select the most appropriate anti-HIV treatment regimen and avoid the use of drugs to which an individual is resistant.

Glossary

genotypic resistance testing

In HIV, genotypic resistance tests are assays that identify mutations of the virus that can confer antiretroviral drug resistance. Resistance testing can be used to guide selection of an HIV regimen when initiating or changing antiretroviral therapy (ART). 

naive

In HIV, an individual who is ‘treatment naive’ has never taken anti-HIV treatment before.

first-line therapy

The regimen used when starting treatment for the first time.

acute infection

The very first few weeks of infection, until the body has created antibodies against the infection. During acute HIV infection, HIV is highly infectious because the virus is multiplying at a very rapid rate. The symptoms of acute HIV infection can include fever, rash, chills, headache, fatigue, nausea, diarrhoea, sore throat, night sweats, appetite loss, mouth ulcers, swollen lymph nodes, muscle and joint aches – all of them symptoms of an acute inflammation (immune reaction).

drug resistance

A drug-resistant HIV strain is one which is less susceptible to the effects of one or more anti-HIV drugs because of an accumulation of HIV mutations in its genotype. Resistance can be the result of a poor adherence to treatment or of transmission of an already resistant virus.

The treatment guidelines of the British HIV Association recommend that all HIV-positive patients should have a genotypic resistance tests before commencing antiretroviral therapy. A study conducted in Germany and recently reported on aidsmap.com noted that antiretroviral naïve-patients with primary drug resistance who had their anti-HIV therapy selected after resistance testing had as favourable a response to first-line HIV treatment as patients with wild-type HIV.