Management of HIV-infected patients with multidrug-resistant virus.
Treatment-experienced patients with HIV may harbor virus that has accumulated several mutations conferring decreased susceptibility to one or more antiretroviral drugs. For clinicians treating these patients, identifying a tolerable antiretroviral regimen with a reasonable chance of a durable virologic effect represents a major challenge. The first priority is to identify and correct the mechanisms responsible for previous treatment failure. Resistance testing and drug level monitoring may be useful in this setting. The patient's history of antiretroviral drug tolerability, comorbidities, and concomitant medications should be considered. Patients embarking on multiple-drug regimens will require close monitoring for adherence, toxicities, and drug-drug interactions. The guiding principle when constructing a rescue or salvage regimen is to achieve a cumulative activity score greater than 2, recognizing that some agents will have only partial activity. Some new drugs are available that may be helpful if used carefully with an active background regimen.
Harris
Marianne
M
British Columbia Centre for Excellence in HIV/AIDS, Providence Health Care/University of British Columbia, 667-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
Montaner
Julio S G
JS
D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000069446:Atazanavir Sulfate; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D024921:Drug Resistance, Multiple, Viral; D004359:Drug Therapy, Combination; D000077560:Enfuvirtide; D015700:HIV Envelope Protein gp41 / Q000009:adverse effects / Q000627:therapeutic use; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D009842:Oligopeptides / Q000009:adverse effects / Q000627:therapeutic use; D063065:Organophosphonates / Q000009:adverse effects / Q000627:therapeutic use; D010446:Peptide Fragments / Q000009:adverse effects / Q000627:therapeutic use; D011725:Pyridines / Q000009:adverse effects / Q000627:therapeutic use; D011753:Pyrones / Q000009:adverse effects / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D013449:Sulfonamides; D000068698:Tenofovir; D017211:Treatment Failure; D019562:Viral Load
D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents; D015700:HIV Envelope Protein gp41; D009842:Oligopeptides; D063065:Organophosphonates; D010446:Peptide Fragments; D011725:Pyridines; D011753:Pyrones; D013449:Sulfonamides; D000077560:Enfuvirtide; D000069446:Atazanavir Sulfate; D000068698:Tenofovir; D000225:Adenine; C107201:tipranavir