Summary of findings for the main comparison. Resistance testing versus no resistance testing in HIV‐positive people.

Resistance testing versus no resistance testing in HIV‐positive people
Patient or population: HIV‐positive people Setting: all settings Intervention: resistance testing Comparison: no resistance testing
Outcomes	Anticipated absolute effects* (95% CI)		Relative effect (95% CI)	Number of participants (trials)	Certainty of the evidence (GRADE)	Comments
	Risk with no resistance testing	Risk with resistance testing
Mortality	Study population		OR 0.89 (0.36 to 2.22)	1140 (5 RCTs)	⊕⊕⊕⊝ MODERATEa,b,c Due to imprecision	Resistance testing probably has little or no impact on mortality
	22 per 1000	20 per 1000 (8 to 47)
Virological failure	Study population		OR 0.70 (0.56 to 0.87)	1728 (10 RCTs)	⊕⊕⊝⊝ LOWa,d,e,f Due to risk of bias and publication bias	Resistance testing may reduce the risk of virological failure
	660 per 1000	576 per 1000 (521 to 628)
Change in CD4 cell count	Mean change in CD4 cell count was 0.	MD 1 lower (12.49 lower to 10.5 higher)	‐	1349 (7 RCTs)	⊕⊕⊕⊝ MODERATEa,d Due to risk of bias	Resistance testing probably has little or no effect on change in CD4 cell count
Progression to AIDS	Study population		OR 0.64 (0.31 to 1.29)	809 (3 RCTs)	⊕⊕⊕⊝ MODERATEg Due to indirectness	Resistance testing probably has little or no impact on progression to AIDS
	67 per 1000	44 per 1000 (22 to 85)
Adverse events	Study population		OR 0.89 (0.51 to 1.55)	808 (4 RCTs)	⊕⊕⊝⊝ LOWh,i Due to risk of bias and indirectness	Resistance testing may have little or no effect on adverse effects
	74 per 1000	66 per 1000 (39 to 110)
Change in viral load	Mean change in viral load was 0.	MD 0.23 lower (0.35 lower to 0.11 lower)	‐	1837 (10 RCTs)	⊕⊕⊕⊝ MODERATEa,j Due to risk of bias	Resistance testing probably results in a lower viral load
Quality of life ‐ not reported	‐	‐	‐	‐	‐	‐
New opportunistic infection ‐ not reported	‐	‐	‐	‐	‐	‐
*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). Abbreviations: CI: confidence interval; MD: mean difference; OR: odds ratio; RCT: randomized controlled trial
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect

^aRisk of bias: all studies included for this outcome were not blinded, but we did not downgrade for this, as lack of blinding is unlikely to introduce bias.
 ^bRisk of bias: one included study was at high risk of bias overall, but it contributed 16.1% of the data (Wegner 2004). We did not downgrade for this.
 ^cDowngraded by 1 for imprecision: CIs for the odds ratio include considerable harm and considerable benefit. We downgraded one point for this.
 ^dDowngraded by 1 for risk of bias: four of the included studies (˜ 37% of data) were at high or unclear risk of bias (Cingolani 2002;Cohen 2002;Haubrich 2005;Rubini 2002).
 ^eIndirectness: the included studies used different cutoffs to define virological failure. We did not downgrade for this.
 ^fDowngraded by 1 for publication bias: based on funnel plot asymmetry and a positive Egger's test.
 ^gDowngraded by 1 for indirectness: "progression to AIDS" was not defined uniformly across studies.
 ^hDowngraded by 1 for risk of bias: all studies included for this outcome were not blinded and adverse events could be interpreted subjectively.
 ⁱDowngraded by 1 for indirectness: "adverse event" was not defined uniformly across studies. We downgraded one point for this.
 ^jDowngraded by 1 for risk of bias: four of the included studies (˜ 34% of data) were at high or unclear risk of bias (Cingolani 2002;Cohen 2002;Haubrich 2005;Rubini 2002).