Genotyping, a commonly used method of determining appropriate HIV treatment for adults, may not work as well for pediatric HIV patients, US researchers reported. "HIV genotyping has been beneficial when choosing salvage regimens in adults failing highly active antiretroviral therapy [HAART]," explained Nicole J. Cohen and colleagues working at the University of Chicago Hospitals.

Cohen and coauthors, however, found evidence suggesting that HIV genotyping is less effective at predicting children's response to treatment. The researchers analyzed therapy outcomes for 18 children who underwent viral genotyping after failing to respond to their initial HAART regimen. Participants underwent a progress review every three months for one year after genotyping.

Ten patients changed HAART regimens after HIV genotyping, but none of these patients achieved a virologic response to their altered therapy, study data showed. By contrast, one of the eight children who maintained the original regimen after genotyping showed a durable reduction in viral load one year later.

In two-thirds of the children studied, HIV genotyping revealed viral resistance mutations to drugs with which they had not yet been treated.

"This study did not demonstrate substantial clinical benefit to HIV genotyping in antiretroviral agent-experienced pediatric patients with high viral loads," Cohen and colleagues concluded. "However, medication history alone does not appear to be an adequate alternative to genotyping in choosing salvage regimens in antiretroviral agent-experienced children."

Their report, "Response to Changes in Antiretroviral Therapy After Genotyping in Human Immunodeficiency Virus-Infected Children," was published in Pediatric Infectious Disease Journal (2002;21(7):647-653).

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