Is Genotypic Testing at First HIV Virologic Failure Worth It?

Genotypic resistance testing (GRT) at first antiretroviral therapy (ART) regimen failure is recommended in the U.S. but is not routine in Sub-Saharan Africa. Investigators sought to determine if GRT improves virologic outcomes at 9 months compared with standard of care (SOC; adherence counseling followed by a regimen change if necessary) in this population. Between December 2016 and December 2019, 840 participants in Uganda and South Africa with HIV RNA levels >1000 copies/mL were randomized 1:1 to receive GRT-guided ART management or SOC. At enrollment, all participants were on a nonnucleoside reverse-transcriptase inhibitor (NNRTI)–containing regimen; 72% were receiving tenofovir (TDF), lamivudine or emtricitabine, and efavirenz.

In the GR…