| Managing Resistance to
HIV Therapy |
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Rational Treatment Sequencing
Even in individuals who initially respond well to drug treatment, virological control
(maintenance of undetectable viral load) may fail eventually (Figure 2). A long term
treatment plan is therefore likely to involve a sequence of different anti-HIV drug
combinations. If therapeutic benefit is lost it seems logical to switch to other drugs
that the individual has not previously tried and to which HIV is unlikely to be resistant.
Figure 2: Durability of response to
Triple Therapy
106 Indinivar optimal responders (Virological Load (VL) <500 copies/ml
before week 24 and maintained for >12 weeks)
Holder DJ. HIV Drug Resistance Workshop, St Petersburg 1997: Abstract 129
Choice of initial and subsequent drug therapy should be
both uncompromising in terms of drug activity and based rationally on a knowledge of drug
resistance and cross-resistance patterns. However, issues such as drug tolerability
(severity of side-effects), convenience of administration and low potential for drug
interactions will also be critical, because therapy is likely to be life-long12 (Table 1).
Table 1: Principles guiding drug choice in therapy combinations
Switching anti-HIV treatment as soon as there are signs of drug failure (increased viral
load), or when the first mutation is detected, may limit the development of further
mutations that may adversely affect the course of the disease or response to subsequent
therapies.
Treatment Choices
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