Fourteen antiretroviral drugs are now Food and Drug Administration (FDA)–approved
for the treatment of human immunodeficiency virus (HIV) infection. Patients
must take combination therapy perpetually because rapid virus turnover and
high mutation rates promote drug resistance. The increasing prevalence of
resistance has prompted development of drug resistance assays, and high-throughput
techniques are now commercially available.
This issue of THE JOURNAL contains recommendations, developed by an
international panel of experts, for the use and interpretation of anti-HIV
drug resistance assays.1 Two major analytic
approaches are discussed: genotypic assays that identify particular mutations,
usually point mutations, associated with resistance; and phenotypic assays
that measure the ability of the patient's virus to grow in the presence of
known concentrations of anti-HIV drugs. Although these techniques are scientifically
sophisticated and exciting, they present dilemmas for the clinician and patient.
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