HIV genotypic drug resistance testing: digging deep, reaching wide?
Supplement : Abstracts of the 2016 International Symposium on HIV and Emerging Infectious Diseases (ISHEID)Journal of Virus Eradication 2016; 2 supplement 1
Abstract No : S4
Kristel Van Laethem
University of Leuven, Leuven, Belgium
For many years, population-based Sanger sequencing has enabled personalized strategies for the treatment of Human Immunodeficiency Virus Type 1 infected patients in resource-rich settings. At diagnosis and entry into care, genotypic testing is to uncover transmitted drug resistance while at virological failure, causality assessment of failure is the aim. In both instances, the detected mutation profile guides the clinician in the subsequent selection of a potent antiviral therapy. Often, the data generated within this framework are subsequently used for research and surveillance purposes: to understand therapy responses and to gain insights into epidemiological processes. In the absence of simple and affordable resistance tests, resource-limited settings opted for a public health approach with the implementation of drug resistance surveillance at sentinel sites to guide the decisions on country-wide antiviral therapy programs. Next-generation sequencing may enable the roll-out of powerful genotypic testing in both resource-rich and –limited settings and contribute to a more comprehensive assessment of the emergence and spread of drug resistance and how to maintain long-term suppressive antiviral therapy. The decision whether these new technologies can transit from research purposes to clinical and epidemiological settings will largely depend on the strength of findings from large studies. From such efforts, continuous growth of data and knowledge will speed up the development of standardized testing systems, covering wet-lab automation to bioinformatics pipelines, and guidance documents for its clinical implementation.