Effectiveness of transmitted drug resistance testing before initiation of antiretroviral therapy in HIV-positive individuals. JAIDS
Lodi et al. on behalf of the HIV-CAUSAL Collaboration aimed to estimate the effectiveness of transmitted drug resistance (TDR) testing, when used according to current guidelines, on virological and clinical outcomes up to 5 years after HIV diagnosis among individuals diagnosed with HIV in Europe and Canada.
The authors included individuals from the HIV-CAUSAL Collaboration who enrolled
Of 25’672 eligible individuals (82% males, 52% diagnosed in 2010 or later), 17’189 (67%) were tested for TDR within 3 months of baseline. Of these, 6% had intermediate- or high-level TDR to any antiretroviral drug. The estimated 5-year proportion virologically suppressed was 77% under TDR testing and 74% under no TDR testing; HR 1.06 (95% confidence interval: 1.03 to 1.19). The estimated 5-year risk of AIDS or death was 6% under both strategies; HR 1.03 (95% confidence interval: 0.95 to 1.12).
In conclusion, the study found a low prevalence of TDR in high-income countries. In individuals diagnosed with HIV in high-income countries, the authors estimated that current recommendations for TDR testing, compared with no TDR testing, increased the proportion achieving virological suppression by 5 years from diagnosis by 3.7% but with no effect on AIDS or death in this time frame. These results call for more evidence to establish which populations would benefit from selective TDR screening.