The primary goal is to develop better methods for monitoring and optimizing antiretroviral therapy using genotype resistance assays at low levels of HIV-1 viremia. Currently genotype drug resistance assays have become the standard of care in management of HIV, but these tests are unavailable at a HIV RNA level <1000 copies/ml. We hypothesize that providing information on drug resistance mutations to providers will improve clinical outcome as measured by virologic control and exposure to fewer antiretroviral agents. Also, we seek to characterize and determine the significance of intermittent low-level viremia, known as """"""""blips."""""""" Many patients on HAART experience intermittently detectable (>50copies/mL) low-level HIV-1 viremia, raising concerns about emerging resistance and eventual treatment failure. We plan to characterize the basic frequency, durations and magnitude of """"""""blips."""""""" Moreover, by analyzing the genotype of the virus present before, during, and after a """"""""blip,"""""""" we will be able to determine if there is evidence for evolution of resistance mutations in order to provide a scientific basis for deciding whether and how best to change therapy in persons that experience """"""""blips.""""""""
| Nettles, Richard E; Kieffer, Tara L; Parsons, Teresa et al. (2006) Marked intraindividual variability in antiretroviral concentrations may limit the utility of therapeutic drug monitoring. Clin Infect Dis 42:1189-96 |
| Nettles, Richard E; Keiffer, Tara L; Cofrancesco Jr, Joseph et al. (2005) Psychological distress and physical pain appear to have no short-term adverse impact on plasma HIV-1 RNA levels in patients on successful HAART. HIV Clin Trials 6:262-71 |
| Nettles, Richard E; Kieffer, Tara L; Kwon, Patty et al. (2005) Intermittent HIV-1 viremia (Blips) and drug resistance in patients receiving HAART. JAMA 293:817-29 |
| Nettles, Richard E; Kieffer, Tara L; Simmons, Rachel P et al. (2004) Genotypic resistance in HIV-1-infected patients with persistently detectable low-level viremia while receiving highly active antiretroviral therapy. Clin Infect Dis 39:1030-7 |
