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Clinical
and laboratory guidelines for the use of HIV-1 drug resistance testing
as part of treatment management: recommendations for the European
setting [The EuroGuidelines Group for HIV Resistance. AIDS
2001;15:309]: This
document represents the guidelines for HIV resistance testing for
Europe. This is described as unique compared to the USA due to "greater
diversity of HIV-1 subtypes, including recombinants, which can affect
ART efficacy and drug susceptibility." The guidelines are ranked
by the strength of the recommendation (1-3) and the quality of supporting
evidence (A-C). The following summarizes the guidelines:
|
EuroGuidelines
for HIV Resistance Testings
|
Level
|
Strength
of Evidence |
Setting |
1
1
1
1
1-2
2
2-3 |
B
B
A
B
B
B
C |
Primary
HIV-treatment- naïve
Post-exposure prophylaxis
Treated patients with virologic failure
Pregnancy
Pediatrics-born to mother on therapy
Chronic infection untreated
Pediatrics-chronic infection |
Comment: These guidelines appear to be fairly liberal in
terms of supporting the use of resistance testing in virtually every
category of HIV infection. Thus, the difference is a matter of degree.
Unlike the guidelines of DHHS or IAS-USA, the authorities here strongly
recommend resistance testing for post-exposure prophylaxis and pregnancy.
No distinction is made between genotypic- and phenotypic-based assays,
although it is acknowledged that interpretation of both tests "is
a complex and developing science."
posted
3/20/2001
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