Advances in antiretroviral therapy (ART) make it possible for healthcare professionals (HCPs) and their patients to consider a regimen switch in some situations to optimize long-term therapy.1,2 Switching or simplifying ART may help improve safety and tolerability. Some regimen switches may be necessary, for example, to address drug toxicities. Others, such as moving from multi- to single-tablet regimens (STRs), may help make daily treatment easier on patients and lead to improved adherence.
The underlying goal of any regimen switch is to maintain viral suppression without limiting future ART options.1 It’s important to carefully review patients’ ART history—past virologic response, ARV-associated toxicities, and resistance test results—as well as any potential drug-drug interactions (DDIs) with concomitant medications before selecting a new regimen. Patient readiness to switch, insurance restrictions, and other supporting evidence may also be considered.2 In patients with a history of virologic failure and drug resistance to one or more drug classes, an HIV specialist should be consulted.
Reasons to consider an ART regimen switch may include1:
Reducing pill burden and/or dosing frequency
Enhancing tolerability of the regimen
Decreasing short- or long-term toxicity
Preventing or mitigating DDIs
Eliminating food or fluid requirements
CONTINUED EVOLUTION OF ART
Today’s standard of care offers an increasing number of approved therapy options in nine mechanistic drug classes that offer durable virologic efficacy, high genetic barrier to resistance, improved side effect profiles, and reduced pill burden.3,4 Generally, two- and three-drug regimens (2DRs and 3DRs) are recommended for regimen switches in treatment-experienced patients who have achieved viral suppression.1
Since the 1990s, 3DRs have been used to target different steps in the HIV life cycle, a treatment strategy shown to improve immunologic function.3 In the early 2000s, “cocktail” regimens became available as once-daily STRs, further facilitating ease of use and treatment adherence.1,5
More recently, 2DRs have demonstrated noninferiority to 3DRs and are being used as a simplification strategy in some treatment-experienced patient populations.1-3 To date, monotherapy has not been proven to be an effective or reliable option.
After a regimen switch, patients should be closely monitored to assess tolerability, safety, viral suppression, and adherence.1 If there are no new complaints, abnormalities, or viral rebound after 3 months, monitoring can resume on a regular basis.
1. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. Department of Health and Human Services. https://clinicalinfo.hiv.gov/sites/default/files/inline-files/AdultandAdolescentGL.pdf. Accessed September 20, 2020. 2. Chastain D, Badowski M, Huesgen E, et al. Optimizing antiretroviral therapy in treatment-experienced patients living with HIV: a critical review of switch and simplification strategies. J Int Assoc Provid AIDS Care. 2019;18:1-22. 3. Badowski M, Perez SE, Silva D, et al. Two’s a company, three’s a crowd: a review of initiating or switching to a two-drug antiretroviral regimen in treatment-naïve and treatment-experienced patients living with HIV. Infect Dis Ther. 2020;9:185-208. 4. FDA-approved HIV medicines. National Institutes of Health website. https://hivinfo.nih.gov/understanding-hiv/fact-sheets/fda-approved-hiv-medicines. Accessed September 22, 2020. 5. The history of FDA’s role in preventing the spread of HIV/AIDS. US Food and Drug Administration website. https://www.fda.gov/about-fda/virtual-exhibits-fda-history/history-fdas-role-preventing-spread-hivaids. Accessed September 22, 2020.
HVUWCNT200013 November 2020
You may also be interested in:
HIV and Coronavirus (COVID-19)
Review interim guidance for treating people living with HIV regarding COVID-19
By clicking "Allow," you will be taken to a separate website.
By clicking "Allow," you will be taken to a website that is independent of ViiV Healthcare. The site you are linking to is not controlled or endorsed by ViiV Healthcare, and ViiV Healthcare is not responsible for content provided on that site.