Front-line HIV Drug-Resistance Testing Should be New Standard of Care for Untreated Patients

HIV Treatment

Brigham and Women's Hospital (BWH), a leader in HIV drug-resistance research, has now determined that testing HIV patients for drug resistance prior to beginning treatment both improves survival and is cost effective. The cost analysis coupled with data on improved survival suggests that resistance testing at the time of diagnosis should be accepted as the new standard of care. The findings are published in the November 1, 2005 issue of the journal, Clinical Infectious Disease, now available online.

Currently, the blood test measuring HIV resistance is used after individuals show signs of treatment failure. Paul Sax, MD, clinical director of the HIV Program at BWH and lead researcher of the study, believed investment in earlier testing up-front would likely increase survival sufficiently to justify cost. Collaborating with a group of researchers from Massachusetts General Hospital and the Harvard School of Public Health, Sax employed a computer model of HIV disease that compared survival and cost both with and without up-front resistance testing. His findings confirmed the original hypothesis: front-line drug resistance testing increases survival by up to 14 months - and importantly was highly cost-effective compared with other tests and interventions routinely done in both HIV positive and negative patients.

Even before this study, Infectious Disease experts at BWH have been administering the resistance test at the time of HIV diagnosis, before starting therapy. "Unfortunately, HIV drug resistance, which now is found in eight to ten percent of all newly-diagnosed HIV patients, is on the rise," said Sax. "The good news today is that we have demonstrated resistance testing at the time of diagnosis - before treatment begins - is a strategy that can increase survival at a very reasonable cost to patients, hospitals, and insurers."

The resistance test BWH uses costs approximately $400, and it is likely to continue dropping in price according to Sax. As noted in the study, this up-front cost is less than 0.2 percent of the total lifetime cost of caring for someone with HIV, making the test extremely cost-effective. The test involves drawing a small blood sample during an office visit, with results returning in approximately five business days. HIV clinical experts determine the best course of treatment based on interpretation of the diagnostic results.

"With more than 20 HIV medications currently available, genotype resistance testing prior to the start of therapy can help offer patients an individualized treatment plan," said Sax. "Based on our cost-effectiveness model, we are urging HIV clinicians to consider testing for resistance in untreated patients right away, at the time of diagnosis. Patients should also talk to their doctors about this new approach. There is no longer a good reason to wait."

The study was funded by the National Institutes of Health and the Centers for Disease Control and Prevention.