February 2011
This guide includes information about changing treatment. The main focus is on treatment failure because of drug resistance. This guide will help explain: why your treatment failed, which tests you need and what the results mean, choices for your next combination, how to help make sure your next treatment works.
It includes information about drugs in development and other research.
Summary
Introduction
Changing treatment and drug resistance
- Reasons to change treatment
- What is second-line treatment?
- How long should I use my first combination?
- How can drugs ‘fail’ and I feel fine?
- What is HIV drug resistance?
Resistance and adherence
What to do if viral load rebounds
Important monitoring tests
- Viral load tests
- Resistance tests
- How to interpret resistance tests
- TDM (Therapeutic Drug Monitoring)
- IQ and VIQ
- Viral tropism
- Getting the tests in the UK
Why a combination can fail
Choosing your next combination
- How do I choose the strongest combination?
- Which combination to change to
- After first treatment failure
- After multiple treatment failure
- How to choose new drugs
- Using up options
Other treatment strategies
- Intensify treatment
- Using T-20
- Using five or more drugs
- Treatment interruptions
- Drug boosting and recycling
- Drugs in development
- Using viral fitness
- Benefit of staying on treatment (using drugs that are still active)
Changing treatment to avoid side effects
Expanded access and experimental drugs
Record your treatment
Further information
Glossary
Credits and disclaimer
Tables and diagrams
References
This guide was written and compiled by Simon Collins for HIV i-Base. Thanks to the advisory group of HIV-positive people and healthcare professionals for comments and to Monument Trust for funding this publication.