Why a combination can fail
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.
If adherence was the cause, you will need support to make sure this doesn’t happen on the new combination.
Any choice to change treatment should be informed by the reason your current treatment failed. This is usually due to one or more of the six reasons below.
You need to find a way of not repeating the same patterns in your next combination.
| Reasons a combination can fail | What to do about it | |
|---|---|---|
| 1) You did not have enough information or support to understand how to use treatment. | Treatments can fail because the DRUGS are not good enough, but they are the best we have. Treatment can fail because good adherence or resistance was not explained properly.
Or because you were not able to understand the importance of each dose. |
ASK questions about your treatment until you are happy with the answers. TALK to your doctor, health advisors and your friends.
READ community leaflets and websites. Take control of your own health. ASK FOR HELP if you need it. |
| 2) The previous combination was not potent enough. | HIV treatment is complicated.
You may have been using less than three active drugs, or three weaker drugs. |
Use the most potent combination possible. Find out all the choices you have and which might be the most likely to work. |
| 3) You were taking your drugs on time but they were not absorbed by your body properly. | Different people can take the same dose of a drug and get different amounts of the drug absorbed by their body.
Dosing can be weight related – if you are above or below average you may need to adjust the dose. |
Ask for TDM (Therapeutic Drug Monitoring) – an inexpensive test that measures how much drug is absorbed in your blood. TDM can be provided for all UK clinics.
Individual differences can be significant. These tests are for PIs, NNRTIs and T-20. |
| 4) You were already resistant to some of the drugs before you started. | If you added new drugs to others you were already using, this would increase the risk of resistance.
Also, if you were infected with a strain of the virus that was already resistant, for example, to efavirenz. If you then used efavirenz, it wouldn’t have been working for you and you would be using only 1 or 2 active drugs. |
Get a RESISTANCE TEST to find out which drugs you can still use now.
Change as many drugs in your next combination as possible. Avoid drugs that have cross-resistance to drugs in your last combination. |
| 5) You were not taking every dose at the right time. | Adherence is critical and perfect adherence is as good as a new drug.
If you missed or were late with your meds, this could explain why your treatment failed. You also need to follow the diet and food requirements. Ask for support to help you tackle adherence differently this time. |
Ask what ADHERENCE SUPPORT is available at your clinic. Talk to your doctor, nurse or other healthcare worker trained to help adherence. Contact i-Base for more information about other support material.
No matter how good your combination is on paper, if you can’t follow it, or have intolerable side effects, you have to find something you can follow. |
| 6) A drug interaction may have reduced the levels of some or your HIV drugs. | Get a genotypic and/or a phenotypic RESISTANCE TEST to find out which drugs you can still use.
Your HIV doctor and pharmacist need to know about any other drugs or supplements you take to check for potential interactions. See: www.hivdruginteractions.org |
Get a genotypic and/or a phenotypic RESISTANCE TEST to find out which drugs you can still use.
Your HIV doctor and pharmacist need to know about any other drugs or supplements you take to check for potential interactions. See: www.hivdruginteractions.org |