Multidrug resistance: a clinical approach.
OBJECTIVE
New antiretroviral agents have recently become available within existing and new drug classes, increasing treatment options for patients with multidrug-resistant virus. This review discusses the challenges that these new agents pose for the management of treatment-experienced patients.


RESULTS
Recent studies of the efficacy and safety of new antiretroviral drugs illustrate that drug regimens containing new agents are well tolerated and can suppress viremia in even the most drug-resistant patients. The goal of any new regimen should therefore be suppression of plasma HIV RNA levels to less than 50 copies/ml, even in treatment-experienced patients. Patients should be given a regimen with at least two, or preferably three, fully active drugs after careful consideration of their treatment and adherence history, current and prior genotype tests, comorbidities, and concomitant medications. Newer and more tolerable agents also offer the possibility of regimen simplification among patients with multidrug-resistant HIV who are virologically suppressed.


CONCLUSIONS
Clinicians must optimize the pairing and sequencing of recently available antiretroviral agents. Future studies should continue to investigate the optimal use of new agents in order to further improve long-term treatment efficacy in patients with multidrug-resistant HIV infection.
Yazdanpanah
Yazdan
Y
Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing and EA 2694, Faculté de Médecine de Lille, Tourcoing, France. yyazdan@yahoo.com
D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D024921:Drug Resistance, Multiple, Viral; D006678:HIV / Q000187:drug effects; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D019562:Viral Load
D044966:Anti-Retroviral Agents