Using five or more drugs

If you do not have enough new drugs left to make a new combination, and have resistance to drugs from all the current drug classes including integrase inhibitors and other new drugs, you could use more than four drugs in your next combination.

Using as many drugs as possible that may still contribute to reducing your viral load has produced very good results. These combinations often include 2–3 protease inhibitors.

Unfortunately though, the Optima trial that looked at this approach, did not find a benefit from increasing the number of drugs.

What you are trying to do is:

• Use ANY drug that may work.
• Not RELY on a drug that may not work.

The weaker a combination is, the less likely it will work long term. Multi-drug resistant therapy is really a way to buy time until new drugs are developed.

The studies using five or more drugs that reported the best results also used TDM to ensure the most effective individual doses of protease inhibitors and NNRTIs.