HIV treatment failure

Management

• failure defined by
  • failure to achieve one log decrease in viral load after 8 weeks of therapy
  • detectable virus > 400-500 HIV RNA/mL by 6 months
  • unacceptable toxicity 2 evaluate cause(s) of treatment failure,
  • earlier calendar year of starting therapy, in which less potent regimens or less well-tolerated antiretroviral drugs were used
  • higher pretreatment or baseline HIV RNA level
  • lower pretreatment or nadir CD4 count
  • comorbidities (e.g., depression, active substance use)
  • presence of drug-resistant virus (HIV resistance testing)
  • medication non-compliance & missed clinic appointments
  • drug side effects and toxicity
  • suboptimal pharmacokinetics (variable absorption, metabolism, &/or penetration into reservoirs, food/fasting requirements, adverse drug-drug interactions with other medications
  • suboptimal potency of the antiretroviral regimen
  • unknown
• resistance testing on a viral isolate if drug-resistance before choosing an alternative regimen
  • genotypic or phenotypic
• at least 2, preferably 3 new antiretroviral agents should be used if cause of treatment failure cannot be identified & corrected

More general terms

• treatment failure

Additional terms

• alternative antiviral regimens for HIV treatment failure