Management of Treatment-Experienced Patients With HIV

  • Author: Eric S. Daar, MD (More Info)
  • Section Editor: Eric S. Daar, MD
  • Editors in Chief: Daniel R. Kuritzkes, MD; Joseph J. Eron, Jr., MD
  • Last Reviewed: 7/13/21 (What's New)

Summary

  • DHHS (Management Guidelines)[DHHS ART] and IAS-USA (Management Guidelines)[IAS-USA ART] define treatment goal as increasing disease-free survival by suppressing plasma HIV-1 RNA to undetectable levels
  • Clinicians must identify active antiretroviral agents (Table) based on detailed treatment history and review of all drug-resistance testing results in the context of what treatment regimen the patient was taking at the time of testing
  • Treatment-experienced patients have a good chance of viral suppression if they receive a fully active pharmacologically boosted PI or second-generation INSTI (eg, dolutegravir and probably bictegravir), with NRTIs, or in combination with each other. If these options are not available, the optimal regimen would include 2, and preferable 3, fully active drugs from other classes.[Steigbigel 2010; Eron 2013b; Hardy 2010; Katlama 2010; Tashima 2015; Gandhi 2020]

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