Intensify treatment

There is an exception to the general rule of always changing as many drugs as possible. This is when, under some circumstances, you can add in a single new drug to your existing combination.

This can include:

• Adding a drug you have never used.
• Adding a drug you have already used but which may still work.
• Adding a drug you used before but did not get resistance too (for example, AZT during pregnancy).

You should only aim to intensify by adding a completely new drug while your viral load is still falling or if it has stabilised.

If you intensify after your viral load has started to rebound or when it is higher than 500 copies/mL, you may be adding monotherapy to a failing combination. You then run the risk of developing resistance to the new drug.

You can also intensify by boosting current drugs. Here you increase the potency of the combination by increasing the levels of some drugs.

• Add a drug that boosts the levels of one of your current drugs
• Increase the dose of a drug if drug level monitoring tests (see ‘TDM (Therapeutic Drug Monitoring)’ and ‘IQ and VIQ’) have shown that you are not absorbing adequate concentrations at the regular dose.

Intensification by boosting drugs can be done even if your viral load has started to go up. If it is done early, this may get you below detection again without developing new resistance to your current drugs.