Clinical approach to drug resistance interpretation: expert advice.

PURPOSE OF REVIEW

The body of knowledge regarding antiretroviral drug resistance is rapidly evolving as a result of extensive research and the continuous availability of new antiretroviral drugs. The interpretation of drug resistance tests may be difficult for clinicians not working in highly specialized healthcare environments. This may lead to inadequate treatment decisions, and can compromise the efficacy of antiretroviral regimens.

RECENT FINDINGS

Several studies have demonstrated better virological outcomes if the design of second and subsequent antiretroviral treatment lines incorporates expert advice in addition to genotypic resistance testing. The benefits of expert advice are limited to therapies to treat the second antiretroviral failure and probably extend to four or five failures. It confers no additional benefit if multiple and equally effective treatment options are available (i.e. after the first antiretroviral treatment failure) or if treatment alternatives are severely limited (i.e. after multiple treatment lines have failed). Conference calls provide a means of improving the availability of healthcare providers.

SUMMARY

Expert advice helps to optimize the design of salvage therapy after the second to the fourth or fifth treatment failure. It provides a continuous update to clinicians and can be made easily and broadly available through conference calls.