David Vlahov

Hiv-1 Resistance in Supervised Treatment Settings: Predictors and Consequences of Drug Resistance Inpatients with Late Stage Human Immunodeficiencyvirus -1 Disease in Supervised Treatment Settings David Vlahov

Positive treatment outcomes for patients with HumanImmunodeficiency Virus-1 (HIV-1) disease may becompromised by the selection of HIV-1 drug resistantmutants (HIVDRM), particularly in marginalizedpopulations where fragmented care is prevalent. Adherence as an important co-factor in selectingHIVDRMs has been controversial. Thus, understandingthe causes and effects of HIVDRMs in the contextadherence is provocative. In this monograph, wesynthesize the literature on antiretroviralresistance testing and discuss its use as a publichealth tool. We conducted an investigation of theresistance testing effects on treatment outcomesamong patients with late stage HIV-1 disease insupervised treatment settings in NYC. The genotypicsensitivity score (GSS), a summary measure of regimenpotency in the context of HIVDRM was examined for itspredictive effects on treatment outcomes, emergenceof resistance and viral evolution. While a higher GSSwas positively, independently associated with viralsuppression, the measure was not predictive ofimmunologic, clinical, subsequent appearance ofHIVDRMs or viral evolution in this supervisedtreatment setting.