HIV drug resistance testing: is the evidence really there?

OBJECTIVES

To assess the strength of evidence supporting the routine use of HIV drug resistance testing.

DESIGN

A critical review of all studies relating to the clinical utility of HIV resistance testing, with a focus on randomized trials.

RESULTS

Two cohort studies found no evidence of a difference in virological response in patients who had resistance testing compared with matched controls. We identified nine published randomized trials that were specifically designed to assess the clinical utility of drug resistance testing. In a meta-analysis of these trials, resistance testing increased the proportion of patients who achieved undetectable viral load by an average of 7% (95% confidence interval: 3-11%). However, this may be an over-estimate of the impact of resistance testing in clinical practice because of the idealized design and analytical approaches used in most of the studies.

CONCLUSIONS

The available evidence does not clearly demonstrate that HIV drug resistance testing is clinically effective. To optimize their value for health decision-making, future trials of HIV resistance testing should be carefully designed to mimic the circumstances of routine clinical practice.