Hirsch M S, Brun-Vézinet F, D'Aquila R T, Hammer S M, Johnson V A, Kuritzkes D R, Loveday C, Mellors J W, Clotet B, Conway B, Demeter L M, Vella S, Jacobsen D M, Richman D D
Harvard Medical School, Boston, Mass, USA.
JAMA. 2000 May 10;283(18):2417-26. doi: 10.1001/jama.283.18.2417.
Assays for drug resistance testing in human immunodeficiency virus type 1 (HIV-1) infection are now available and clinical studies suggest that viral drug resistance is correlated with poor virologic response to new therapy. The International AIDS Society-USA sought to update prior recommendations to provide guidance for clinicians regarding indications for HIV-1 resistance testing.
An International AIDS Society-USA 13-member physician panel with expertise in basic science, clinical research, and patient care involving HIV resistance to antiretroviral drugs was reconvened to provide recommendations for the clinical use of drug resistance testing.
The full panel met regularly between January and October 1999. Resistance and resistance testing data appearing in the last decade through April 2000 and presentations at national and international research conferences were reviewed. Recommendations and considerations were developed by 100% group consensus, acknowledging that definitive data to support final recommendations are not yet available.
Emerging data indicate that despite limitations, resistance testing should be incorporated into patient management in some settings. Resistance testing is recommended to help guide the choice of new regimens after treatment failure and for guiding therapy for pregnant women. It should be considered in treatment-naive patients with established infection, but cannot be firmly recommended in this setting. Testing also should be considered prior to initiating therapy in patients with acute HIV infection, although therapy should not be delayed pending the results. Expert interpretation is recommended given the complexity of results and assay limitations.
目前已有针对人类免疫缺陷病毒1型（HIV-1）感染的耐药性检测方法，临床研究表明病毒耐药性与对新疗法的病毒学反应不佳相关。美国国际艾滋病协会试图更新先前的建议，为临床医生提供有关HIV-1耐药性检测指征的指导。
重新召集了一个由13名医生组成的美国国际艾滋病协会小组，他们在涉及HIV对抗逆转录病毒药物耐药性的基础科学、临床研究和患者护理方面具有专业知识，以提供耐药性检测临床应用的建议。
整个小组在1999年1月至10月期间定期开会。回顾了截至2000年4月的过去十年中出现的耐药性和耐药性检测数据，以及在国内和国际研究会议上的报告。通过100%的小组共识制定了建议和注意事项，同时承认支持最终建议的确切数据尚未获得。
新出现的数据表明，尽管存在局限性，但在某些情况下，耐药性检测应纳入患者管理。建议进行耐药性检测，以帮助指导治疗失败后新治疗方案的选择以及指导孕妇的治疗。对于已确诊感染的初治患者应考虑进行检测，但在此情况下不能强烈推荐。对于急性HIV感染患者，在开始治疗前也应考虑进行检测，不过不应因等待结果而延迟治疗。鉴于结果的复杂性和检测局限性，建议由专家进行解读。
