Poster presentation at:
XVIII International AIDS Conference
18th July 2010 - 23rd July 2010
Revell AD1, Mican J2, Agan B3, Coe D1, Wang D1, Rivera-Goba M4, Metcalf J2, Pozniak A5, Perez Elias MJ6, Montaner JS7, Lane HC2, Larder BA1.
1 The HIV Resistance Response Database Initiative (RDI), London, UK
2 National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
3 Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
4 National Institutes of Health, Clinical Center, Bethesda, MD, USA
5 Chelsea and Westminster Hospital, London, UK
6 Ramon Y Cajal Hospital, Madrid, Spain
7 BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
Background The optimal selection and sequencing of ART is challenging, not least because of the complexity of drug resistance and the range of drugs available. The HIV Resistance Response Database Initiative (RDI) has developed computational models that predict an individual's virological response to ART. These models are being used to power a web-based ART selection tool. In this retrospective study, the system was evaluated by HIV-experienced physicians in clinical practice in the USA.
Method: Sixty-five historical cases of ART failure were reviewed by 21 physicians as if a treatment decision were being made at the current time. Thirty-nine cases were reviewed by two different physicians giving 104 cases overall. The physicians entered the patients' data and their initial treatment decision into the system via the RDI website; received a report listing the system's predictions of response to the physician's selection and possible alternatives; entered their final treatment decision and finally completed an online evaluation questionnaire.
Results Physicians rated entering baseline data as very or quite easy (86%), satisfactory (10%) and difficult (5%). The RDI report was rated as very or quite easy to understand (71%) and satisfactory (29%). The system was rated as quite useful (24%), satisfactory (43%) and not very useful (33%). They would use RDI very or quite frequently (34%), sometimes (48%), infrequently (14%) and never (5%). Use of the system was associated with a change of treatment decision in one-third of cases and an average saving in the number of drugs in the final regimen selected of approximately 10%.
Discussion: The RDI system was judged as user-friendly, potentially helpful and likely to be used in practice. Use of the system may result in a reduction in the number of drugs prescribed and potentially lower treatment costs. A randomized, controlled trial will be needed to determine the overall value of adding this tool to standard of care.