DHHS Guidelines Highlight Importance of Achieving Viral Suppression When Choosing New ARV Agents1
ARV regimen considerations for treatment-experienced patients
suppression is essential
The primary goal of treatment for ART-experienced patients with drug resistance experiencing virologic failure is to establish viral suppression.
Potency is critical
For patients with virologic failure, consider expected potency of additional agent(s), taking into account the patient's ART history, resistance, and availability of a new MOA.
INCLUDES 2-3 FULLY ACTIVE AGENTS
For multiple or extensive drug resistance with few treatment options, a new regimen should include at least 2, and preferably 3, fully active agents (including those with novel mechanisms of action). If choosing a regimen with fewer than 3 fully active drugs, include as many fully active drugs as possible, along with potentially partially active drugs (BII).*
*DHHS guidelines rating BII = Moderate recommendation supported by data from well-designed nonrandomized trials of observational cohort studies with long-term clinical outcomes. DHHS guidelines rating of Strength of Recommendation: A = Strong; B = Moderate; C = Weak. Quality of Evidence: I = Data from randomized controlled trials; II = Data from well-designed nonrandomized trials or observational cohort studies with long-term clinical outcomes; III = Expert opinion.
Beware of cross-resistance
The use of a new drug does not ensure that it will be fully active due to the potential for cross-resistance among drugs from the same class.