Though the prevalence of virologic failure (VF) in patients with HIV has decreased as newer antiretroviral (ART) regimens with higher genetic barriers to resistance and reduced toxicity have been approved, VF can still occur. VF may be due to patient, viral, or ART factors, and it is critical that clinicians determine the underlying cause before switching ART regimens so they can work with the patient to select the most appropriate regimen. Resistance will affect selection of subsequent regimens for patients experiencing VF, particularly among those with multidrug resistance (MDR). All patients experiencing VF should undergo resistance testing, and clinicians should engage in shared decision-making when selecting ART regimens, to ensure the patient can be adherent.
Heavily treatment-experienced (HTE) patients with MDR have had few options specifically designed to supplement an optimized background regimen, but these options have expanded over the last several years, and there is hope that this small subset of patients will have even more options in the future. In this eHealth activity, Drs David Wohl and Jürgen Rockstroh discuss evaluation of VF, selection of subsequent regimens for patients experiencing VF, and recently approved and emerging options for HTE patients, including how to create and simplify salvage regimens for these patients.
