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14th Annual Conference of the British HIV Association23–25 April 2008, Belfast |
THE IMPACT OF RESISTANCE TESTING IN ARV-NAÏVE PATIENTS: DOES IT GUIDE OPTIMAL THERAPY SELECTION AND IMPROVE LONG-TERM OUTCOMES?
HIV Med 2008; 9(Suppl. 1):3 (abstract no. O8)
L Bansi1, AM Geretti1, D Dunn2 and C Sabin1, UK CHIC Steering Committee1
1Royal Free and University College Hospital, London, UK, 2Medical Research Council, Clinical Trials Unit, London, UK
BACKGROUND: Transmitted drug resistance (TDR) may lead to some patients starting sub-optimal treatment regimens. We report the resistance mutations and genotypic sensitivity scores (GSS) of all patients within the UK Resistance Database and CHIC cohort who had a resistance test performed whilst ART-naïve and who subsequently started HAART.
METHODS: The proportion of patients with mutations regarded as indicative of TDR and detectable resistance to any drug as part of their initial HAART regimen were calculated. GSS were calculated using the Stanford interpretation algorithm and logistic regression was used to identify factors associated with patients having a low GSS score (<3). Cox regression was used to identify factors associated with achieving an undetectable viral load (UD VL) of <50 copies/mL.
RESULTS: Of 1175 patients who had a resistance test and subsequently started HAART, 116 (9.9%) had at least one detectable mutation, 64 (5.4%) had at least one mutation to the drugs in their initial HAART regimen and, 54 (4.6%) had a GSS<3. In multivariable analyses, patients with GSS<3 were more likely to start HAART with ritonavir-boosted PIs (OR =1.86 [CI: 1.02, 3.42], p=0.02) and in earlier calendar years (1999-2001 versus >2004) (2.50 [1.15, 5.42]). 763/935 (81.6%) patients with a baseline viral load achieved an UD VL after starting HAART (median 3.4 [2.4, 5.5] months). GSS was found to be independently associated with achieving an UD VL (HR = 1.50 (95% CI:1.19, 1.89), p=0.001).
CONCLUSIONS: Patients with low GSS tend to have poorer long-term outcomes and hence, as well as tolerability, selection of first-line HAART should take into account the presence of transmitted drug resistance, together with other recognised predictors of virological outcomes.
2008-04-23
O8
Copyright © 2008 - British HIV Association (BHIVA) Reproduction of this abstract (other than one copy for personal reference) must be cleared through the BHIVA Organising Secretariat 1 Mountview Court, 310 Friern Barnet Lane, London N20 0LD