HIV and ID Observations

Head over to this page from Janssen Diagnostics, and you’ll receive this little pop-up message:

Must say it’s in some ways sad to see it go — in my opinion the nifty work they did correlating genotype results with their database of phenotypes gave the clearest representation of what a genotype actually means. If you didn’t want to order both genotype and phenotype simultaneously — which was expensive and took weeks to come back from the lab — vircoTYPE was was the most efficient way to get information on complex resistance patterns. Sure, one could quibble about methodology and validation of the test, but it was remarkable indeed to send a genotype and get back results estimating fold-change, upper and lower cut-offs, full and partial activity — and virus clade, just for kicks.

But am I surprised it’s disappearing? Not if you think about it for a moment. As is plainly obvious to anyone doing HIV care, the incidence of new patients with the sort of HIV drug resistance for which the test was developed has plummeted. There simply aren’t many new patients out there who have multiple mutations, especially in the PI-drug class, and who will need the computational black-box firepower provided by a vircoTYPE. A regular genotype does just fine for those who are newly diagnosed, or have virologic failure on a first-line regimen due to poor adherence.

What about the existing patients with this sort of resistance? Most are virologically suppressed right now, and hence don’t need resistance tests anymore.

And in a nice irony, it’s in part the antiretrovirals made by the therapeutics branch of this company — darunavir in particular, etravirine as well — that have made the vircoTYPE obsolete. These two drugs, plus raltegravir, mean that most people with resistance are suppressed.

So for posterity’s sake, here’s a “beautiful” (what a nerdy thing to write) vircoTYPE from one of those patients, the test obtained in the late 2000s:

His current situation? Virologically suppressed on darunavir, etravirine, raltegravir, of course.