Michael S. Saag, MD
Disclaimer: Dr. Saag has served as a consultant for three companies (Virco, ViroLogics, and Roche Diagnostics) involved in the development, manufacturing, or sale of products used in HIV resistance testing. In addition, he has collaborated with Virco and ViroLogics in clinical trials designed to evaluate the effectiveness of HIV resistance testing among patients followed in a clinical cohort.
Requests for Single Reprints: Michael S. Saag, MD, University of Alabama at Birmingham, CCB Room 178, 908 20th Street South, Birmingham, AL 35294-2050.
Saag MS. HIV Resistance Testing in Clinical Practice: A QALY-fied Success. Ann Intern Med. 2001;134:475-477. doi: 10.7326/0003-4819-134-6-200103200-00012
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Published: Ann Intern Med. 2001;134(6):475-477.
Despite the significant advances in HIV therapy over the past 5 years, failure of highly active antiretroviral therapy (HAART) remains a significant problem. In a meta-analysis of 21 treatment groups from randomized clinical studies, only 46% of patients were able to reach the targeted HIV RNA viral load (<50 copies/mL) by 48 weeks (1). Because of virologic rebound or toxicity, the initial regimen ultimately fails even in most patients who are at first treated successfully. Therefore, HAART failure is common and should be anticipated by all clinicians caring for HIV-infected patients.
The management of HAART failure depends on the reason for failure and the availability of alternative therapies. The most common causes of HAART failure are difficulties in adherence, short-term intolerance, long-term toxicities (such as lipodystrophy, insulin resistance, and hyperlipidemias), insufficient drug levels, and development of virologic resistance. Management of adherence and treatment-related toxicities involves detailed discussions with the patient and identification of an acceptable new regimen. Evaluation of insufficient drug levels is challenging and requires formal pharmacologic testing, a procedure not available in most clinical settings.
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Infectious Disease, HIV.
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Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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