inPractice® - Insufficient Suppression or Viral Rebound With Consistently Low Levels of Plasma HIV-1 RNA in Those With a History of Limited or No Drug Resistance

Persistently detectable virus at insufficient levels for resistance testing (HIV-1 RNA 200-1000 copies/mL) is distinct from clinically irrelevant “blips”
Initial focus should be to assess adherence and potential for drug–drug or drug–food interactions
Considerable data support modifying the regimen of treatment–experienced patients to include 3 fully active agents or a fully active ritonavir-boosted PI with other fully or partially active drugs or dolutegravir in INSTI-naive patients plus 2 NRTIs where at least 1 is fully active^{[Aboud 2019]}