Treatment of antiretroviral-drug-resistant HIV-1 infection.
Drug-resistant HIV-1 is a cause of growing clinical and public-health concern. In many patients, combination antiretroviral therapy fails to achieve complete viral suppression (virological failure). Continuing viral replication during therapy leads to the accumulation of drug-resistance mutations, resulting in increased viral load and a greater risk of disease progression. Patients with drug-resistant HIV-1 infection have three therapeutic options: a change to a salvage regimen with the aim of fully suppressing viral replication; interruption of therapy; or continuation of a partially effective regimen. The first strategy is preferred for most patients failing their first or perhaps their second regimen. However, the best approach remains unclear for patients who have failed multiple treatment regimens and who have limited options for complete viral suppression. The management of such patients requires a careful understanding of the pathogenesis of drug-resistant HIV-1, the clinical consequences of virological failure, the potential benefits and limitations of diagnostic assays, and the likelihood that agents in development will be effective.
Deeks
Steven G
SG
University of California, San Francisco, and San Francisco General Hospital, San Francisco, California 94110, USA. sdeeks@php.ucsf.edu
D019380:Anti-HIV Agents / Q000276:immunology* / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D024882:Drug Resistance, Viral / Q000235:genetics / Q000276:immunology; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D017320:HIV Protease Inhibitors / Q000276:immunology / Q000627:therapeutic use; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics / Q000276:immunology; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D019438:Ritonavir / Q000276:immunology / Q000627:therapeutic use; D016896:Treatment Outcome; D019562:Viral Load / Q000706:statistics & numerical data; D014779:Virus Replication / Q000187:drug effects / Q000276:immunology
D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D019438:Ritonavir