Modifying Antiretroviral Therapy in Virologically Suppressed HIV-Infected Patients

  • Author: José R. Arribas, MD (More Info)
  • Section Editor: Eric S. Daar, MD
  • Editors in Chief: Joseph J. Eron, Jr., MD; Daniel R. Kuritzkes, MD
  • Last Reviewed: 3/17/20 (What's New)

Summary

  • First goal of regimen modification is to maintain undetectable HIV-1 RNA
  • Replacing a PI With a NRTI or NNRTI
    • Patients who are currently receiving a suppressive regimen of 2 NRTIs plus a PI and who harbor NRTI resistance mutations are at increased risk of virologic failure from switching to an NNRTI[Martínez 2003]
      • NNRTIs have a low genetic barrier to resistance and must be supported by an active background regimen rather than one that has been weakened by the presence of NRTI resistance
    Replacing a Boosted PI With Raltegravir or Elvitegravir/Cobicistat
      Replacing a Fusion Inhibitor With Raltegravir

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