Researchers
recommend drug-resistance testing before anti-HIV drugs are
started

Researchers at Brigham and Women's Hospital in Boston are urging that U.S. HIV-treatment guidelines be changed to include drug-resistance testing for all HIV patients before antiretroviral therapy is initiated because of the likelihood that they may have been infected with virus already resistant to one or more anti-HIV drugs. Currently, drug-resistance tests are usually offered only to HIV patients who are experiencing treatment failure to help pinpoint which of their medications is no longer effective in stopping HIV replication. Pretreatment testing both improves the survival of patients and is cost-effective, the researchers write in the November 1 issue of the journal Clinical Infectious Diseases, which is now available online.

Using a computer model comparing patient survival times and cost of drug-resistance testing, the researchers discovered that frontline testing increased patient survival by up to 15 months and was highly cost-effective compared with other tests and intervention routines done for both HIV-positive and HIV-negative patients.

"Unfortunately, HIV drug resistance, which now is found in 8% to 10% of all newly diagnosed HIV patients, is on the rise," says researcher Paul Sax in a press release. "The good news today is that we have demonstrated resistance testing at the time of diagnosis--before treatment begins--is a strategy that can increase survival at a very reasonable cost to patients, hospitals, and insurers."

The resistance test BWH currently uses costs approximately $400, and it is likely to continue dropping in price, according to Sax. This up-front cost is less than 0.2% of the total lifetime cost of caring for an HIV-positive person, making the test extremely cost-effective.

"With more than 20 anti-HIV medications currently available, genotype resistance testing prior to the start of therapy can help offer patients an individualized treatment plan," says Sax in a press release. "Based on our cost-effectiveness model, we are urging HIV clinicians to consider testing for resistance in untreated patients right away at the time of diagnosis. Patients should also talk to their doctors about this new approach. There is no longer a good reason to wait."

The study was funded by the National Institutes of Health and the Centers for Disease Control and Prevention. (Advocate.com)