The goal of prescribing antiretroviral therapy (ART) to people living with HIV is maintaining plasma HIV RNA levels below the lower limits of detection (LLOD) of current assays, which helps to preserve immunologic function and reduces HIV-associated morbidity and mortality.1 Patients who cannot achieve virologic suppression or experience virologic rebound may develop resistance to one or more components of their regimen, limiting future treatment options.
When HIV RNA levels persist above 200 copies/mL, patients are considered to be in virologic failure.1 Virologic failure may result from adherence-related factors, which can stem from psychosocial challenges, comorbidities, adverse drug effects, and more. It may also result from factors related to HIV, such as having acquired drug-resistant virus, or ART regimen factors, including suboptimal pharmacokinetics or virologic potency, low genetic barrier to resistance, and drug-drug interactions with concomitant medications. Distinguishing among different causes of virologic failure is important when considering approaches to subsequent therapy.
Evaluation of virologic failure includes assessments of1:
Drug-drug and drug-food interactions
HIV RNA level and CD4 count over time
Drug-resistance test results
Managing treatment-experienced patients failing ART is complex, and consulting with an expert is recommended.1 To help guide therapy, drug resistance testing should be performed, ideally while the patient is still taking the failing regimen or within 4 weeks of discontinuation. Subsequently, the new regimen selected should include at least 2 fully active agents that have uncompromised activity on the patient’s HIV.
Fully active antiretroviral agents1:
Have uncompromised activity based on patients’ ART history and resistance test results
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. Available at https://clinicalinfo.hiv.gov/sites/default/files/inline-files/AdultandAdolescentGL.pdf. Accessed October 9, 2020.
HVUWCNT200007 October 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.