Benefit of staying on treatment using drugs that are still active
Even if you have a detectable viral load and are waiting for new treatments, staying on treatment with nukes and a protease inhibitor is safer than stopping all your drugs.
This is especially true if your CD4 count is less than 200 cells/mm3.
It is definitely better to continue to use treatment compared to just stopping treatment altogether.
These combinations should include nukes plus one or two protease inhibitors even if you have resistance to current drugs.
Continuing treatment is especially important if you have a CD4 count less than 200 cells/mm3.
If you have a high viral load, then there may not be any benefit from continuing to use NNRTIs, T-20 or integrase inhibitors. If a resistance test shows that you have the key mutations associated with resistance to these drugs, then they are unlikely to be contributing any activity against HIV.
However, if you do not have other treatments to choose, especially if you have a low CD4 count, then as long as you are able to tolerate treatment, nukes and PIs are likely to still provide some benefit.
This strategy prioritises keeping your CD4 count at a safe level over the risk of developing resistance. If the next new drug you are waiting to use is a PI, then some researchers suggest cutting back to a nuke-only ‘holding’ regimen. This will reduce the risks of developing further cross-resistance to the new PI.
If the next drug you are waiting for is a nuke, it may be better to use boosted-PIs in the holding regimen.
This benefit may continue for several years while new drugs are developed but it will not continue forever. Closer monitoring should be carried out if you are in this situation.