AEGiS-14IAC: Genotype testing practices in a HIV clinic in New York City.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Genotype testing practices in a HIV clinic in New York City.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. B10179)

Suh JS, Ristau PE, Warford R, Sharp V
St. Luke's-Roosevelt Hospital, The Center for Comprehensive Care, New York City, New York 10025, United States

Backgound: Testing for HIV drug resistance has become an important adjunct to guide antiretroviral management. Current guidelines (Department of Health and Human Services and IAS-USA) recommend incorporating resistance tests for management of patients (pts) experiencing failure on antiretroviral (ARV) therapy. Despite these guidelines, the utility of resistance testing vary considerably in clinical practice. The study objective was to examine how and when genotype tests were used in a multidisciplinary HIV clinic in New York City.

METHODS: Retrospective chart review of pts who had genotype tests (Visible Genetics) ordered during the period November 2000 to December 2001.

RESULTS: Total of 215 pts (196 adults and 19 children) had genotype testing during this 13-month period. The median CD4 count was 220 cells/mm³ (range: 2 to 1218), median plasma HIV viral load = 29,523 copies/mL (range: 1.5K to >750K). The number of prior ARV regimens pts had been on at time of genotyping were as follows: naïve- 4(2%), 1st line- 22(10%), 2nd- 39(18%), 3rd- 38(18%), 4th-24(11%), greater than 4th/salvage- 86(40%). Reasons indicated by clinicians for genotyping were the following: virologic failure- 182(85%), ARV change due to side effects- 18(8%), pts who had self discontinued ARVs for greater than 2 months (drug holiday) and wanted to resume therapy-6(3%), pts requesting simplified regimen- 5(2%), and pts with chronic HIV infection about to start ARVs- 4(2%).

CONCLUSIONS: The majority of pts who had genotype tests ordered were on their 4th line or greater regimen. This may reflect the higher therapeutic failure rates in more ARV experienced pts. Virologic failure on ARV therapy, was the predominate reason given for testing, but genotypes were also ordered for situations not generally recommended by published guidelines, such as pts not on ARVs. Follow-up study is in process to determine rate of virologic suppression in this cohort utilizing genotype testing.

Keywords: AEGIS, HIV Infections, CD4 Lymphocyte Count, Acquired Immunodeficiency Syndrome, Genotype, HIV Seropositivity, New York City, Follow-Up Studies, Retrospective Studies, Adult, Child, Human, genetics

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B10179