DISCLAIMER

The applications accessible from this site are for demonstration purposes only. They have not been validated for clinical use and must not be used for real patient encounters.


Demonstrations of clinical applications
RetroGram    
Decision support for drug regimens for HIV-infected patients

developed by clinical domains keywords
InferMed Ltd, UK; Virology Networks, Netherlands. Treatment of HIV Decision support systems, Arezzo, PROforma
status access demonstrator
In use by more than 250 clinicians in European, Australian and US centers in resistance management of over 2,000 HIV-1 infected patients.

RetroGram

Virtual demonstration - the visitor is guided through the system's functionality.

The Flash demo can either be viewed over the Web or downloaded.

description

RetroGram relates complex genomic information on HIV-1 resistance to the clinical suitability of anti-retroviral drugs. The system generates a suitability ranking of all FDA approved drugs based on their expected clinical efficacy for an individual patient. It includes the experience and opinions of experts in the algorithm to weigh the effect of specific genotypic changes.

The decision support technology used in the implementation of RetroGram™ is AREZZO, based on PROforma and developed by InferMed Ltd., London. The medical content was developed by Virology Networks. RetroGram is jointly owned by Virology Networks and Hoffmann-La Roche.

references
C Tural et al. Clinical utility of HIV-1 genotyping and expert advice: the Havana Trial. AIDS. 2002; 16:209-218.

[PubMed]   [aidsonline.com]   [Reuters report on the Havana trial]

" OBJECTIVE: To determine whether HIV-1 genotyping and expert advice add additional short-term virologic benefit in guiding antiretroviral changes in HIV+ drug-experienced patients. DESIGN: A two factorial (genotyping and expert advice), randomized, open label, multi-center trial. The patients were stratified according to the number of treatment failures. PATIENTS AND METHODS: HIV-1 infected patients on stable antiretroviral therapy who presented virological failure were included into the study. Genotypic testing was performed by using TrueGene HIV Genotyping kit and the results were interpreted by a software package (RetroGram, version 1.0). An expert advisory committee suggested the new therapeutic approach based on clinical information alone or on clinical information plus HIV-1 genotyping results. Plasma HIV-1 RNA load, CD4+ cell count and adverse events were recorded at baseline and every 12 weeks. RESULTS: A total of 326 patients were included. The baseline CD4+ cell count and plasma HIV-1 RNA were 387 (+/- 224) x 10(6) cells/l and 4 (+/- 1) log(10) respectively. The proportion of patients with plasma HIV-1 RNA < 400 copies/ml at 24 weeks differed between genotyping and no genotyping arms (48.5 and 36.2%, P < 0.05). Factors associated with a higher probability of plasma HIV-1 RNA < 400 copies/ml were HIV-1 genotyping [odds ratio (OR), 1.7; 95% confidence interval (CI), 1.1-2.8; P = 0.016] and the expert advice in patients failing to a second-line antiretroviral therapy (OR, 3.2; 95% CI, 1.2-8.3; P = 0.016). CONCLUSIONS: HIV-1 genotyping interpreted by a software package improves the virological outcome when it is added to the clinical information as a basis for decisions on changing antiretroviral therapy. The expert advice also showed virologic benefit in the second failure group. "
contact links
Wilco Keulen at Virology Networks BV., Netherlands

E: retrogramatvironet.com

  bullet  More information about RetroGram [AI clinical systems on OC]
acknowledgements
Virology Networks BV, InferMed Ltd.
Entry on OpenClinical: 12 June 2003
Last main update: 13 June 2003
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