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Updated European Recommendations for the Clinical Use of HIV Drug Resistance Testing

2004; SAGE Publishing; Volume: 9; Issue: 6 Linguagem: Inglês

10.1177/135965350400900619

2040-2058

Anne–Mieke Vandamme, Anders Sönnerborg, Mounir Ait‐Khaled, Jan Albert, Birgitta Åsjö, Lee T. Bacheler, Dénes Bánhegyi, Charles A. Boucher, F. Brun-Vézinet, Ricardo Camacho, Philippe Clevenbergh, Nathan Clumeck, Nikos Dedes, Andrea De Luca, Doerr Hw, J-L Faudon, Giorgio Gatti, Jan Gerstoft, WW Hall, Angelos Hatzakis, Nicholas S. Hellmann, Andrzéj Horban, Jens Lundgren, Dale J. Kempf, Michael D. Miller, Veronica Miller, TW Myers, Craig Nielsen, Milos Opravil, Lucia Palmisano, Carlo Federico Perno, Andrew Phillips, Deenan Pillay, Tomàs Pumarola, Lı́dia Ruiz, Mika Salminen, Jonathan Schapiro, Bárbara Schmidt, J.C. Schmit, Rob Schuurman, E Shulse, Vincent Soriano, Schlomo Staszewski, Stefano Vella, M Youle, Rainer Ziermann, Lionel Perrin,

HIV/AIDS Research and Interventions

In most European countries, HIV drug resistance testing has become a routine clinical tool. However, its practical implementation in a clinical context is demanding. The European HIV Drug Resistance Panel was established to make recommendations to clinicians and virologists on this topic and to propose quality control measures. The panel recommends resistance testing for the following indications: i) drug-naive patients with acute or recent infection; ii) therapy failure, including suboptimal treatment response, when treatment change is considered; iii) pregnant HIV-1-infected women and paediatric patients with detectable viral load when treatment initiation or change is considered; and iv) genotype source patient when post-exposure prophylaxis is considered. In addition, for drug-naive patients with chronic infection in whom treatment is to be started, the panel suggests that resistance testing should be strongly considered and recommends testing the earliest sample for drug resistance if suspicion of resistance is high or prevalence of resistance in this population exceeds 10%. The panel does not favour genotyping over phenotype, however it is anticipated that genotyping will be used more often because of its greater accessibility, lower cost and faster turnaround time. For the interpretation of resistance data, clinically validated systems should be used to the greatest extent possible. It is mandatory that laboratories performing HIV resistance tests take regular part in quality assurance programs. Similarly, it is necessary that HIV clinicians and virologists take part in continuous education and meet regularly to discuss problematic clinical cases. Indeed, resistance test results should be used in the context of all other clinically relevant information for predicting therapy response. The panel also encourages the timely collection of epidemiological information to estimate the impact of transmission of resistant HIV and the prevalence of HIV-1 non-B subtypes in the different European countries.