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Primer on interpretation of HIV drug resistance testing

Author
Joel E Gallant, MD, MPH
Section Editor
Martin S Hirsch, MD
Deputy Editor
Jennifer Mitty, MD, MPH

INTRODUCTION

Preventing and managing antiretroviral drug resistance is among the greatest challenges in maintaining durable HIV suppression for the lifetime of an infected patient. Clinicians need to understand the resistance patterns associated with specific antiretroviral medications so that they may appropriately select treatment regimens that will maximize the likelihood of viral suppression [1]. While these patterns can be complex, there are basic principles that underlie effective utilization of resistance data, which should be considered when making decisions about switching drug regimens after virologic failure.

This topic will address the major resistance patterns found in association with different medications and how that knowledge translates into the selection of appropriate treatment regimens. The details in this topic refer mainly to resistance patterns seen with HIV subtype B, which is the most prevalent clade in the United States, Europe, Japan, Thailand and Australia. (See "Global epidemiology of HIV infection" and "Global epidemiology of HIV infection", section on 'Origin of the HIV epidemic'.)

Types of resistance tests and indications for their use are discussed elsewhere, as are factors that contribute to the emergence of drug resistance. (See "Clinical trials of HIV drug resistance testing" and "Drug resistance testing in the clinical management of HIV infection" and "Overview of HIV drug resistance testing assays".)

The selection of antiretroviral therapy (ART) for the treatment-naïve or treatment-experienced patient is found elsewhere. (See "Selecting antiretroviral regimens for the treatment-naïve HIV-infected patient".)

GENERAL PRINCIPLES

Prior to the initiation of antiretroviral therapy (ART), clinicians should obtain a careful medication history to assess the possibility of drug resistance from previous drug exposure.

                                                         

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Literature review current through: Nov 2016. | This topic last updated: Wed Oct 15 00:00:00 GMT+00:00 2014.
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