{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T04:52:21Z","timestamp":1785214341572,"version":"3.55.0"},"reference-count":55,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2019,5,4]],"date-time":"2019-05-04T00:00:00Z","timestamp":1556928000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01AI042006"],"award-info":[{"award-number":["R01AI042006"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R37AI093269"],"award-info":[{"award-number":["R37AI093269"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K01HL123349"],"award-info":[{"award-number":["K01HL123349"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32AI007433"],"award-info":[{"award-number":["T32AI007433"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Steve and Deborah Gorlin MGH Research Scholars Award"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,3,17]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>US guidelines recommend genotype testing at human immunodeficiency virus (HIV) diagnosis (\u201cbaseline genotype\u201d) to detect transmitted drug resistance (TDR) to nonnucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs), and protease inhibitors. With integrase strand inhibitor (INSTI)-based regimens now recommended as first-line antiretroviral therapy (ART), the of baseline genotypes is uncertain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used the Cost-effectiveness of Preventing AIDS Complications model to examine the clinical impact and cost-effectiveness of baseline genotype compared to no baseline genotype for people starting ART with dolutegravir (DTG) and an NRTI pair. For people with no TDR (83.8%), baseline genotype does not alter regimen selection. Among people with transmitted NRTI resistance (5.8%), baseline genotype guides NRTI selection and informs subsequent ART after adverse events (DTG AEs, 14%). Among people with transmitted NNRTI resistance (7.2%), baseline genotype influences care only for people with DTG AEs switching to NNRTI-based regimens. The 48-week virologic suppression varied (40%\u201392%) depending on TDR. Costs included $320\/genotype and $2500\u2013$3000\/month for ART.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Compared to no baseline genotype, baseline genotype resulted in &amp;lt;1 additional undiscounted quality-adjusted life-day (QALD), cost an additional $500\/person, and was not cost-effective (incremental cost-effectiveness ratio: $420 000\/quality-adjusted life-year). In univariate sensitivity analysis, clinical benefits of baseline genotype never exceeded 5 QALDs for all newly diagnosed people with HIV. Baseline genotype was cost-effective at current TDR prevalence only under unlikely conditions, eg, DTG-based regimens achieving \u226450% suppression of transmitted NRTI resistance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>With INSTI-based first-line regimens in the United States, baseline genotype offers minimal clinical benefit and is not cost-effective.<\/jats:p><\/jats:sec>","DOI":"10.1093\/cid\/ciz372","type":"journal-article","created":{"date-parts":[[2019,5,3]],"date-time":"2019-05-03T19:17:08Z","timestamp":1556911028000},"page":"1353-1363","source":"Crossref","is-referenced-by-count":29,"title":["Clinical Impact and Cost-effectiveness of Genotype Testing at Human Immunodeficiency Virus Diagnosis in the United States"],"prefix":"10.1093","volume":"70","author":[{"given":"Emily P","family":"Hyle","sequence":"first","affiliation":[{"name":"Medical Practice Evaluation Center, Department of Medicine"},{"name":"Division of Infectious Diseases, Massachusetts General Hospital"},{"name":"Harvard Medical School, Boston"},{"name":"Harvard University Center for AIDS Research, Cambridge"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justine A","family":"Scott","sequence":"first","affiliation":[{"name":"Medical Practice Evaluation Center, Department of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul E","family":"Sax","sequence":"first","affiliation":[{"name":"Harvard Medical School, Boston"},{"name":"Division of Infectious Diseases and Department of Medicine, Brigham and Women\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia R I","family":"Millham","sequence":"first","affiliation":[{"name":"Medical Practice Evaluation Center, Department of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin M","family":"Dugdale","sequence":"first","affiliation":[{"name":"Medical Practice Evaluation Center, Department of Medicine"},{"name":"Division of Infectious Diseases, Massachusetts General Hospital"},{"name":"Harvard Medical School, Boston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milton C","family":"Weinstein","sequence":"first","affiliation":[{"name":"Harvard Medical School, Boston"},{"name":"Department of Health Policy and Management, Harvard T.H. Chan School of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth A","family":"Freedberg","sequence":"first","affiliation":[{"name":"Medical Practice Evaluation Center, Department of Medicine"},{"name":"Division of Infectious Diseases, Massachusetts General Hospital"},{"name":"Harvard Medical School, Boston"},{"name":"Harvard University Center for AIDS Research, Cambridge"},{"name":"Department of Health Policy and Management, Harvard T.H. Chan School of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rochelle P","family":"Walensky","sequence":"first","affiliation":[{"name":"Medical Practice Evaluation Center, Department of Medicine"},{"name":"Division of Infectious Diseases, Massachusetts General Hospital"},{"name":"Harvard Medical School, Boston"},{"name":"Harvard University Center for AIDS Research, Cambridge"},{"name":"Division of General Internal Medicine, Massachusetts General Hospital, Boston"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,5,4]]},"reference":[{"key":"2020062607534417000_CIT0001","author":"Panel on Antiretroviral Guidelines for Adults and Adolescents","year":"2018"},{"key":"2020062607534417000_CIT0002","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1093\/cid\/ciy463","article-title":"Human immunodeficiency virus drug resistance: 2018 recommendations of the International Antiviral Society\u2013USA Panel","volume":"68","author":"G\u00fcnthard","year":"2019","journal-title":"Clin Infect Dis"},{"key":"2020062607534417000_CIT0003","volume-title":"HIV drug resistance database"},{"key":"2020062607534417000_CIT0004","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.1093\/cid\/cix542","article-title":"Should we be testing for baseline integrase resistance in patients newly diagnosed with human immunodeficiency virus?","volume":"65","author":"Koullias","year":"2017","journal-title":"Clin Infect Dis"},{"key":"2020062607534417000_CIT0005","author":"Panel on Antiretroviral Guidelines for Adults and Adolescents","year":"2006"},{"key":"2020062607534417000_CIT0006","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1056\/NEJMoa013552","article-title":"Antiretroviral-drug resistance among patients recently infected with HIV","volume":"347","author":"Little","year":"2002","journal-title":"N Engl J Med"},{"key":"2020062607534417000_CIT0007","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1093\/cid\/civ102","article-title":"Pretreatment HIV drug resistance and HIV-1 subtype C are independently associated with virologic failure: results from the multinational PEARLS (ACTG A5175) clinical trial","volume":"60","author":"Kantor","year":"2015","journal-title":"Clin Infect Dis"},{"key":"2020062607534417000_CIT0008","first-page":"CD006495","article-title":"Antiretroviral resistance testing in HIV-positive people","volume":"11","author":"Aves","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"2020062607534417000_CIT0009","doi-asserted-by":"crossref","first-page":"1316","DOI":"10.1086\/496984","article-title":"Should resistance testing be performed for treatment-naive HIV-infected patients? 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