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From Medicineworld.org: Drug Resistance Testing is Cost-Effective In New HIV Patients


Drug Resistance Testing is Cost-Effective In New HIV Patients


Many of the patients who are first diagnosed with HIV infection may be harboring drug resistant strains of HIV virus. Drug testing may be done at the time of initial diagnosis in to see if they are indeed sensitive to the drugs that are planned. There was a question that if drug testing in newly diagnosed HIV patients is cost effective. A new study has found that testing for drug resistance in HIV-infected patients at the time of HIV diagnosis is cost-effective and may increase patients’ life expectancy. This study is published in the Nov. 1 issue of Clinical Infectious Diseases, now available online.

Resistance to antiretroviral therapy, even in patients who have never received treatment, is a growing concern. However, genotype resistance testing, which involves looking for the presence of resistance genes, is not a standard procedure at the time a patient is diagnosed with HIV, probably due to lack of data on its benefits and its relatively high cost compared with other routine blood tests.

A cost-effectiveness analysis conducted by a group of Boston scientists indicates that performing genotype resistance testing at initial HIV diagnosis--before treatment is started--can effectively guide a clinician's choice of treatment regimen and increase a patient's quality-adjusted life expectancy. (Quality-adjusted measurements of time reflect that survival with an illness is presumed to be of lower quality than healthy survival.)

"For the approximately 90 percent of patients with no resistance, the testing provides no benefit," said lead author Paul Sax, MD, of Brigham and Women's Hospital. "However, if certain types of resistance are present [when a patient is first diagnosed with HIV], our study projects a substantial increase in survival" of more than 14 months, compared with no resistance testing.

Resistance rates vary from place to place. It is estimated that, in the United States and Europe, the average resistance rate in treatment-naïve patients is between 8 and 10 percent, eventhough baseline resistance may be as high as 16 percent in gay men, "likely reflecting their overall greater access to treatment since the beginning of the epidemic," said Dr. Sax. Using a model with a resistance rate of just over 8 percent, the analysis estimated a cost of $23,900 per quality-adjusted life year gained, which is within the range of other usually accepted HIV interventions. The cost-effectiveness calculation remained below $50,000 per quality-adjusted year gained unless the resistance rate was 1 percent or less, which is much lower than in most areas.

An accompanying editorial commentary by Frederick Hecht, MD, and Robert Grant, MD, of the University of California, San Francisco, agrees that "there is now sufficiently strong information to recommend genotypic resistance testing in all drug naïve patients at the time of diagnosis." However, the authors, who have received support from various pharmaceutical and diagnostic companies, caution that there are some drug resistance mutations that may not be detectable by standard resistance tests.

The cost of performing the one-time test--now about $400--has decreased from when it was first approved, and will likely continue to drop. Some clinicians are not yet convinced of the value of genotype resistance testing, and some insurance companies do not yet cover it, but the practice of resistance testing at initial HIV diagnosis has gradually increased. "We're hoping that this study makes it part of standard care," said Dr. Sax.




Founded in 1979, Clinical Infectious Diseases publishes clinical articles twice monthly in a variety of areas of infectious disease, and is one of the most highly regarded journals in this specialty. It is published under the auspices of the Infectious Diseases Society of America (IDSA). Based in Alexandria, Virginia, IDSA is a professional society representing more than 8,000 clinicians and researchers who specialize in infectious diseases. Nested within the IDSA, the HIV Medicine Association (HIVMA) is the professional home for more than 2,700 clinicians, researchers and other health care professionals dedicated to the field of HIV/AIDS. HIVMA promotes quality in HIV care and advocates policies that ensure a comprehensive and humane response to the AIDS pandemic informed by science and social justice. For more information, visit www.idsociety.org.


Did you know?
Many of the patients who are first diagnosed with HIV infection may be harboring drug resistant strains of HIV virus. Drug testing may be done at the time of initial diagnosis in to see if they are indeed sensitive to the drugs that are planned. There was a question that if drug testing in newly diagnosed HIV patients is cost effective. A new study has found that testing for drug resistance in HIV-infected patients at the time of HIV diagnosis is cost-effective and may increase patients’ life expectancy. This study is published in the Nov. 1 issue of Clinical Infectious Diseases, now available online.

Medicineworld.org: Drug Resistance Testing is Cost-Effective In New HIV Patients


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