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An algorithm‐based genotypic resistance score is associated with clinical outcome in HIV‐1‐infected adults on antiretroviral therapy
Author(s) -
Ormaasen V,
Sandvik L,
Åsjø B,
HolbergPetersen M,
Gaarder PI,
Bruun JN
Publication year - 2004
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/j.1468-1293.2004.00244.x
Subject(s) - medicine , quartile , drug resistance , odds ratio , confidence interval , clinical endpoint , hiv drug resistance , population , genotype , observational study , viral load , disease , antiretroviral therapy , human immunodeficiency virus (hiv) , immunology , randomized controlled trial , biochemistry , chemistry , environmental health , gene , microbiology and biotechnology , biology
Objectives The aim of this study was to evaluate the association between genotypic drug resistance and the occurrence of HIV‐related diseases and death in HIV‐1‐infected adults on antiretroviral therapy. Methods We performed an observational study on patients from an out‐patient clinic in a university hospital. Genotypic drug resistance analysis after virological treatment failure was performed in 141 patients receiving two or more antiretroviral drugs. All patients had follow up of at least 6 months after the resistance test. An algorithm was developed to estimate the level of genotypic drug resistance and to assign an actual resistance score (ARS) for the drugs prescribed to each patient. The patient population was divided into quartiles according to patients' ARS values. Our endpoint was the risk of developing an HIV‐related disease [Centers for Disease Control and Prevention (CDC) category B or C] during the period starting 6 months prior to and ending 6 months after the genotypic resistance test, or death during the 6 months following the resistance test. Results There was a significant association between the level of resistance to the drugs prescribed (ARS) and our clinical endpoint: the odds ratio for an endpoint (with 95% confidence interval) was 3.20 (1.28–7.99), adjusted for CD4 cell count and HIV RNA, in patients in the highest ARS quartile compared with patients in the other three quartiles. Conclusions Our study indicates that patients with high‐level genotypic drug resistance are at increased risk of developing an HIV‐related disease. This association could not be explained by differences in CD4 cell count or HIV RNA levels.