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Use of Genotypic Resistance Testing To Guide HIV Therapy: Clinical Impact and Cost-Effectiveness

Milton C. Weinstein, PhD; Sue J. Goldie, MD, MPH; Elena Losina, PhD; Calvin J. Cohen, MD, MSc; John D. Baxter, MD; Hong Zhang, BA; April D. Kimmel, AB; and Kenneth A. Freedberg, MD, MSc
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From Harvard School of Public Health, Boston University School of Public Health, Harvard Medical School, and Massachusetts General Hospital, Boston, Massachusetts; Community Research Initiative of New England, Brookline, Massachusetts; and Cooper Hospital/University of Medicine and Dentistry of New Jersey and Robert Wood Johnson Medical School, Camden, New Jersey.

Acknowledgments: The authors thank members of the research group on Cost-Effectiveness of Preventing AIDS Complications for valuable guidance: Donald E. Craven, MD; Runa Islam; A. David Paltiel, PhD; and George R. Seage, ScD, MPH. They also thank Karen Kuntz, PhD, and Lisa Sullivan, PhD, for helpful advice.

Grant Support: By the National Institute of Allergy and Infectious Diseases (R01-AI42006) and the Centers for Disease Control and Prevention (U64/CCU 114927).

Requests for Single Reprints: Milton C. Weinstein, PhD, Center for Risk Analysis, Harvard School of Public Health, 718 Huntington Avenue, Boston, MA 02115-5924.

Current Author Addresses: Drs. Weinstein and Goldie: Center for Risk Analysis, Harvard School of Public Health, 718 Huntington Avenue, Boston, MA 02115-5924.

Drs. Losina and Freedberg, Mr. Zhang, and Ms. Kimmel: Division of General Internal Medicine, Massachusetts General Hospital, 50 Staniford Street, Ninth Floor, Boston, MA 02114.

Dr. Cohen: Community Research Initiative of New England, 320 Washington Street, Third Floor, Brookline, MA 02445.

Dr. Baxter: Department of Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Education and Research Building, 401 Haddon Avenue, Second Floor, Camden, NJ 08103.

Author Contributions: Conception and design: M.C. Weinstein, S.J. Goldie, C.J. Cohen, K.A. Freedberg.

Analysis and interpretation of the data: M.C. Weinstein, S.J. Goldie, C.J. Cohen, J.D. Baxter, K.A. Freedberg.

Drafting of the article: M.C. Weinstein.

Critical revision of the article for important intellectual content: M.C. Weinstein, S.J. Goldie, E. Losina, C.J. Cohen, J.D. Baxter, K.A. Freedberg.

Final approval of the article: M.C. Weinstein, S.J. Goldie, E. Losina, C.J. Cohen, J.D. Baxter, H. Zhang, A.D. Kimmel, K.A. Freedberg.

Provision of study materials or patients: J.D. Baxter.

Statistical expertise: E. Losina.

Obtaining of funding: K.A. Freedberg.

Administrative, technical, or logistic support: A.D. Kimmel, K.A. Freedberg.

Collection and assembly of data: E. Losina, C.J. Cohen.

Ann Intern Med. 2001;134(6):440-450. doi:10.7326/0003-4819-134-6-200103200-00008
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Treatment with combinations of antiretroviral drugs that target HIV-1 protease and reverse transcriptase enzymes is effective in reducing HIV-1 replication (1). Use of these regimens, referred to as highly active antiretroviral therapy (HAART), has dramatically reduced HIV-related morbidity and mortality (13). Despite this success, however, treatment failure occurs frequently and is associated with the development of HIV-1 variants that have reduced susceptibility to antiretroviral drugs. It is not clear whether acquired resistance causes treatment failure or whether failure precipitates drug resistance (45). Patients who experience failure of initial HAART, as diagnosed by increasing HIV RNA levels, are given second-line and salvage therapies, but these later regimens have substantially lower success rates than initial therapy, partly because of acquired drug resistance (12, 6).

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Summary for Patients

The Cost-Effectiveness of Testing HIV for Genetic Signs of Drug Resistance as a Guide to the Choice of Therapy

The summary below is from the full report titled “Use of Genotypic Resistance Testing To Guide HIV Therapy: Clinical Impact and Cost-Effectiveness.” It is in the 20 March 2001 issue of Annals of Internal Medicine (volume 134, pages 440-450). The authors are MC Weinstein, SJ Goldie, E Losina, CJ Cohen, JD Baxter, H Zhang, AD Kimmel, and KA Freedberg.


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