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Date of Report: 08/12/2003
Author: Susa Coffey, MD, Associate Medical Editor, AETC NRC
Source: National Resource Center
Description: Analysis
Recommendations for testing for HIV resistance to antiretroviral medications have recently been published by the Department of Health and Human Services (DHHS) and by the International AIDS Society-USA (IAS-USA). The guidelines of the two organizations are fundamentally similar and emphasize both the utility and the limitations of resistance testing.
Both sets of guidelines recommend resistance testing in the setting of acute HIV infection, virologic failure during treatment, and suboptimal response to antiretroviral therapy. Neither of the guidelines recommends the use of one type of resistance assay rather than another (e.g., genotype or phenotype), and both emphasize the importance of consultation with experts in the interpretation of test results.
On several issues, the guidelines differ:
| IAS-USA | DHHS |
| Chronic HIV infection, before treatment | Recommended in patients infected "within previous 2 years and possibly longer" | Should be considered in chronic HIV infection |
| Pregnancy | Recommended in all with detectable plasma HIV RNA | Criteria for testing are the same as for nonpregnant persons |
| HIV viral load threshold | 500-1000 copies/ml | >= 1000 copies/ml |
The complete recommendations can be consulted:
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