The first United States national HIV treatment guidelines recommending the use of drug resistance testing in selected clinical situations was published on the Internet in January 2000. In addition, Aetna U.S. Healthcare has issued a coverage policy bulletin regarding the reimbursement of genotypic and phenotypic resistance tests for its clients with HIV. A widespread program to educate health-care providers about the appropriate use of these tests is being launched by the National Association of AIDS Education and Training Centers (NAAETC) through a series of unrestricted educational grants provided by Laboratory Corporation of America^®.

Updated HIV Treatment Guidelines for Adults and Adolescents
An updated version of the Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents (The Living Document) developed by the Panel on Clinical Practices for Treatment of HIV Infection (convened by the Department of Health and Human Services [DHHS] and the Kaiser Family Foundation) is now available through the ATS web site. The updated Guidelines cautiously recommend the use of resistance assays in patients who experience virologic failure during HAART or suboptimal suppression of viral load after initiation of HAART.

“When combined with detailed drug history and efforts aimed at maximizing adherence, these assays may help to maximize the benefits of antiretroviral therapy…Consultation with an expert in HIV drug resistance is encouraged to facilitate interpretation of genotypic test results…limitations of both genotypic and phenotypic assays include the lack of uniform quality assurance for all assays that are currently available, relatively high cost, and insensitivity for minor viral species…”

The Guidelines do not recommend the use of resistance assays at this time in patients with chronic, untreated HIV infection, or in patients who have discontinued their antiretroviral treatment or have plasma viral loads < 1000 HIV RNA copies/mL. Resistance assays "should be performed while the patient is taking his/her antiretroviral regimen, and data suggesting the absence of resistance should be interpreted carefully in relation to the prior treatment history."

Read the DHHS Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents (The Living Document):

• PDF format: http://www.hivatis.org/guidelines/adult/pdf/A&ajani.pdf
• HTML version: http://www.hivatis.org/trtgdlns.shtml#AdultAdolescent

Education Program About Resistance Testing for Health Care Providers
The National Association of AIDS Education and Training Centers (NAAETC) network is a national program funded through the Ryan White CARE Act that educates physicians, nurses, nurse practitioners, physician assistants, dentists and other health care providers in the prevention and management of HIV/AIDS. Fourteen AIDS Education and Training Centers (AETCs) are based in health science centers that provide care and conduct clinical research in HIV/AIDS. They provide a solid foundation for the development and dissemination of "best practices" from recognized HIV experts to other health care providers. The mission of these centers is to increase the number of providers who are educated and motivated to treat individuals with HIV. With the help of an unrestricted educational grant from Laboratory Corporation of America^® Holdings (LabCorp^®), the NAAETC is creating an in-depth educational program that helps health care providers determine the most beneficial treatment and monitoring regimens for patients with HIV/AIDS. The program will initially target those states that have the largest population of HIV-positive individuals and will focus on the promises and limitations of drug resistance testing in the management of HIV disease.

For more information about this program, contact E. Michael Reyes, MD, National Association of AIDS Education and Training Centers, 415-502-8196. For information about NAAETC, see http://www.ucsf.edu/warmline/subcons/pacific.shtml or http://www.hrsa.dhhs.gov/hab/educating.shtml.

Aetna US Healthcare Resistance Test Coverage Policy
In response to previously published treatment guidelines from the International AIDS Society (IAS)-USA, Aetna's Coverage Policy Bulletin states: "Aetna U.S. Healthcare covers HIV drug susceptibility [phenotypic] and [genotypic] resistance tests for patients that have a confirmed increase in plasma HIV-1 RNA levels despite treatment with antiretroviral combination regimens, and for whom other possible causes of treatment failure have been considered, including poor adherence to medication and other factors causing suboptimal drug levels."

For more details about Aetna's coverage of HIV drug resistance testing, please see Aetna's Website.