Summary

Drug resistance is a specialised area of HIV care. Although everyone’s treatment situation is different, the following summary covers the most important key points from this booklet.

Each summary point is highlighted on the pages where it is discussed later.

1. If your viral load starts to rise after being undetectable, don’t panic, but do take it seriously.
2. Repeat the test on the same day you get the first test results. This is to find out whether the first test was accurate. Collect the new test results as soon as they are available (within 2 weeks).
3. If your viral load continues to rise, the earlier you change treatment (if you have this option), the less resistance will develop. This will make it easier to reduce viral load to undetectable again.
4. Think about why your current combination failed. Find out whether this related to resistance, problems with adherence, drug absorption, or a combination of these reasons. This also applies if your first combination never reduced your viral load to undetectable levels.
   If adherence was the cause, you will need support to make sure this doesn’t happen on the new combination.
5. Ask whether your doctor is experienced in treating people in your situation. If you are being treated at a clinic with relatively few patients, your doctor can talk to experts at larger centres.
6. Choose the strongest combination you can for the next treatment. Use as many new drugs that are not cross-resistant to previous drugs.
7. Monitor your new treatment carefully. Get a viral load test 2–4 weeks after the treatment change. Then test viral load every month until you know if you are undetectable. If you have problems with adherence or side effects, discuss these with your doctor.
8. Keep up-to-date on the latest research. Find out which new treatments are likely to become available in the next year, especially through expanded access programmes.
9. Don’t rush to use one new drug if it is the only drug that will be active, especially if your health is good. Always try to use at least two new drugs in your combination.
10. Even if you have a detectable viral load and are waiting for new treatments, staying on treatment that includes nukes and a protease inhibitor is much safer than stopping all your drugs. This is especially true if your CD4 count is under 200.