Management of Treatment-Experienced HIV-Infected Patients

  • Author: Eric S. Daar, MD (More Info)
  • Section Editor: Eric S. Daar, MD
  • Editors in Chief: Joseph J. Eron, Jr., MD; Daniel R. Kuritzkes, MD
  • Last Reviewed: 7/16/19 (What's New)

Summary

Introduction

  • HIV-infected patients needing to modify treatment due to virologic failure have several highly active and well-tolerated options
  • First step in optimizing treatment is defining potential obstacles to success, such as factors associated with poor treatment adherence[Chesney 2006]
  • Selecting a new regimen requires determining which agents are likely to be virologically active for a given patient and using them in effective combinations

Principles for Managing the Treatment-Experienced HIV-1-Infected Patient

    Defining Treatment Failure
    • Treatment failure defined as either of the following outcomes with the most recent antiretroviral regimen:
      • Failure to achieve undetectable plasma HIV-1 RNA levels
      • Undetectable plasma HIV-1 RNA followed by sustained virologic rebound with persistently detectable plasma HIV-1 RNA
    • DHHS guidelines define virologic failure as confirmed HIV-1 RNA > 200 copies/mL (Management Guidelines)[...

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