inPractice® - Managing Patients With First-line Virologic Failure and No or Minimal Drug Resistance

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: 3/21/21 (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 or bictegravir with NRTIs is unlikely to select for PI or INSTI resistance^{[Gallant 2015; Clotet 2014; Walmsley 2013; Daar 2011; Sax 2017; Gallant 2017]}

First-line NNRTI Failure

Based on available data, the combination of 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

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Keywords: Management of Treatment-Experienced Patients, Resistance Testing