Max B, Badri S, Barker D, Falusi OM; International Conference on AIDS.
Int Conf AIDS. 2002 Jul 7-12; 14: abstract no. MoPeB3130.
CORE Center, Chicago, Chicago, IL, United States
BACKGROUND: The cost of care for HIV+ patients (pts) is expanding. Genotypic resistance testing (GRT) is increasingly used in routine clinical care, but is expensive and should be used judiciously. 10-35% of isolates in clinic cohorts using GRT have been WTV suggesting pt non- adherence. Due to limited resources, our institution implemented guidelines for GRT. We studied the impact of these guidelines on the rate of WTV detection. METHODS: Retrospective review of all GRT obtained as part of routine clinical care at the CORE Center, Chicago between 9/00 and 1/02. To obtain GRT, pts had to be currently on antiretroviral (ARV) therapy, have an HIV RNA > 5,000 copies/ml and considered adequately adherent. To demonstrate adherence pts had to be compliant with clinic visits, the provider assessed ARV adherence and the case was reviewed with an Infectious Diseases physician. Most pts were also evaluated by the on-site clinical pharmacist, (CP), who assessed adherence with screening questions including pill count, dosing frequency, pill recognition and number of missed doses. RESULTS: There were 187 GRT performed. Most pts were highly treatment experienced; 44 (24%) were failing their first regimen. WTV was sequenced in 8 pts (4.3%). The other 179 pts demonstrated resistance mutations consistent with their present or previous ARV. The CP fully evaluated 116(62%) pts who obtained GRT; 2 of 8 pts who had WTV were not evaluated by the CP. Of the other 6 pts; 3 had poor adherence but GRT was still approved, 1 pt was treatment naive but physician insisted on GRT and 2 were assessed to be adherent and eligible for the test. CONCLUSIONS: The 4% rate of WTV is much lower than has been reported in the literature. In a resource limited setting, use of strict guidelines for ordering GRT was effective in keeping detection of WTV to a minimum and reducing the number and thus cost of non-useful tests.
Publication Types:
Keywords:
- Acquired Immunodeficiency Syndrome
- Ambulatory Care Facilities
- Anti-HIV Agents
- Chicago
- Guidelines as Topic
- HIV
- HIV Infections
- HIV Protease
- HIV Seropositivity
- Humans
- Mass Screening
- Treatment Refusal
- epidemiology
- reverse transcriptase, Human immunodeficiency virus 1
Other ID:
UI: 102252865
From Meeting Abstracts