Impact of genotypic resistance testing on physician selection of antiretroviral therapy.
OBJECTIVES: To determine the impact of genotypic resistance testing on physician selection of antiretroviral therapy. STUDY DESIGN/METHODS: This was a prospective, observational study. A single genotypic resistance test was done when patients failed highly active antiretroviral therapy. The antiretroviral regimen predicted at the time the genotypic resistance assay was done was compared with the regimen that was ultimately selected after review of resistance testing results. RESULTS: In the vast majority of cases (83%), the regimen that the physician selected after resistance testing was different from the predicted regimen. In 54% of cases, these changes involved changing more than two antiretroviral agents, and in 22%, one agent was changed. In 1% of cases, all medications were discontinued, and in 6%, the physician ultimately decided not to change the baseline regimen. Although patients were screened for nonadherence to their medication regimen, 11% had no detectable resistance mutations. CONCLUSIONS: Access to genotypic resistance testing has a significant impact on physician selection of antiretroviral therapy.
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