Management of Treatment-Experienced HIV-Infected Patients

  • 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: 8/1/18 (What's New)

Summary

  • Most common results of resistance testing in patients experiencing treatment failure of first-line regimens report either no significant resistance or resistance to lamivudine or emtricitabine with or without NNRTI[Gallant 2006; Riddler 2008] or INSTI resistance,[Rockstroh 2013; Clumeck 2014; Wohl 2014] depending upon which regimen is used
  • First-line therapy with ritonavir- or cobicistat-boosted PIs or dolutegravir with NRTIs is unlikely to select for PI or INSTI resistance[Gallant 2015; Clotet 2014; Walmsley 2013; Daar 2011]
  • First-line NNRTI Failure
    • Based on available data, the combination of a lopinavir/ritonavir plus either NRTIs or twice-daily raltegravir can be used to successfully treat patients experiencing virologic failure of first-line NNRTI-based therapy
      First-line INSTI Failure
        First-line Ritonavir-Boosted PI Failure
          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

          Action required