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HIV treatment failure
Management:
1) 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
3) resistance testing on a viral isolate if drug-resistance before choosing an alternative regimen [2]
- genotypic or phenotypic
4) at least 2, preferably 3 new antiretroviral agents should be used if cause of treatment failure cannot be identified & corrected
Related
alternative antiviral regimens for HIV treatment failure
General
treatment failure
References
- Panel on Antiretroviral Guidelines for Adults and
Adolescents. Guidelines for the use of antiretroviral
agents in HIV-1-infected adults and adolescents.
Department of Health and Human Services. Nov 3 , 2008.
http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf
- Medical Knowledge Self Assessment Program (MKSAP) 14, 15
American College of Physicians, Philadelphia 2006, 2009