Smith T F
Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
Infect Dis Clin North Am. 2001 Dec;15(4):1263-94. doi: 10.1016/s0891-5520(05)70193-8.
The control of the global expansion and proliferation of the AIDS pandemic has been complicated by the emergence of resistant strains of HIV-1 to the many new antiviral drugs directed to the genes coding for reverse transcriptase and protease enzymes of the virus. Similarly, new drug regimens for the management of chronic hepatitis B and C infections have been complicated by the lack of sustained clinical responses recently associated with either nucleotide mutation (HBV) or specific genotype of the virus (HCV). Commercial systems for performing and interpreting genotypic analysis will facilitate the recognition of informative mutations, standardize results between laboratories, and produce informative and interpretative result formats for optimal treatment of patients. Drug-resistant strains of herpesviruses (HSV, VZV, CMV) are generally associated with prolonged treatment of these infections in immunocompromised patients. Ultimate relevance of genotypic assays for routine clinical practice will require correlation with phenotypic results and the outcomes of long-term studies associating clinical improvement with antiviral drugs with specific mutation patterns of these viruses.
针对病毒逆转录酶和蛋白酶编码基因的多种新型抗病毒药物出现了HIV-1耐药毒株，这使得全球艾滋病大流行的扩张和传播控制变得复杂。同样，慢性乙型和丙型肝炎感染的新药治疗方案也因缺乏持续的临床反应而变得复杂，这种反应最近与核苷酸突变（乙肝病毒）或病毒特定基因型（丙肝病毒）有关。用于进行和解释基因分型分析的商业系统将有助于识别有意义的突变，使各实验室之间的结果标准化，并生成信息丰富且可解释的结果格式，以实现对患者的最佳治疗。疱疹病毒（单纯疱疹病毒、水痘带状疱疹病毒、巨细胞病毒）的耐药毒株通常与免疫功能低下患者这些感染的长期治疗有关。基因检测对于常规临床实践的最终相关性将需要与表型结果以及将临床改善与这些病毒特定突变模式的抗病毒药物相关联的长期研究结果相关联。
