A new, free online system launched in London last week offers an exciting new resource in pairing HIV-positive people with successful drug combinations. Using this system, called HIV-TRePS, physicians will be able to reduce the guesswork that is too often involved in pairing HIV-positive patients with medications.
The HIV Treatment Response Prediction System (HIV-TRePS) is the work of a London non-profit group called the Response Database Initiative. They have created a system capable of predicting the efficacy of various drug combinations for a single individual, using simulations based on the medical records of over 70,000 HIV-positive people worldwide. The system is only about 80 percent accurate, so it should not be seen as a perfect model—but given that other methods have roughly 54 percent accuracy, it is a big step forward. There are well over 20 different HIV drugs available, after all; prescribing just the right combination of them for each individual is difficult—particularly given that new, drug-resistant strains are constantly evolving.
HIV-TRePS is also likely to be most useful for the people who are the toughest to treat—those who have already been through two or three failed drug combinations. With first-time HIV treatments, most of the approved and available drug combinations will be effective, so a physician will focus on choosing a drug that the patient can easily take and that has the fewest side effects. But once two or three combinations have failed, physicians turn to genotype tests, which examine a person's individual HIV for its drug-resistant mutations. Using the results of those tests to choose a next treatment option is a complex process, and it is this that HIV-TRePS facilitates. A physician can enter into the system an individual's genotype test results, viral load, CD4 count and previous treatments. The system then returns the possible treatments, along with their strength and tolerability.
For people with access to major hospitals and university research centers, this system will supplement the expertise at their disposal. But for the developing world, where resources are slim and HIV is prevalent, this could be a very helpful new tool. Dr. Julio Montaner, Past President of the International AIDS Society and Director of the BC Centre for Excellence in HIV and AIDS, based in Vancouver, Canada, has said, “This is a very exciting development—the system literally puts the experience of treating thousands of different patients at the doctor’s fingertips. This has the potential to improve outcomes for people living with HIV and AIDS around the world, particularly where resources and expertise are scarce.”