Changing an HIV Treatment Regimen

Will my HIV treatment regimen ever change?

An effective treatment regimen prevents HIV from making copies of itself. If the anti-HIV medications you take aren't controlling the virus, you may need to adjust or change your regimen. However, before changing regimens, it's important to understand why your treatment regimen is not working effectively.

Why do treatment regimens fail?

HIV treatment regimens can fail for a variety of reasons, including:

• Side effects from anti-HIV medications
  Unpleasant side effects, such as fatigue, nausea, and diarrhea, can make treatment adherence difficult. Severe side effects make it impossible to safely follow a regimen.
• Poor absorption of anti-HIV medications
  To work effectively, anti-HIV medications must be absorbed by the body.
• Drug interactions
  Drug interactions between anti-HIV medications and other medications can increase the risk of side effects. Drug interactions can also reduce the effectiveness of anti-HIV medications. (Anti-HIV medications can also have the same effects on other medications.)
• Drug resistance
  Drug resistance occurs when HIV mutates (changes form), causing one or more medications in a regimen to be ineffective.
• Poor treatment adherence
  Skipping medications gives HIV the chance to multiply, increasing a person's viral load. Poor adherence also increases the risk of drug resistance.

Your health care provider will do many things to help prevent treatment failure. For example, your health care provider will monitor you closely for side effects and drug interactions. Drug-resistance testing will help your health care provider determine which anti-HIV medications will and will not be effective against your strain of HIV. And to make adherence easier, your health care provider can simplify your regimen so that you take fewer pills (or take them less often during the day).

If my treatment regimen fails, how will my health care provider select a new regimen?

Sometimes adjusting medications to avoid side effects or drug interactions or taking steps to improve adherence is not enough; your treatment regimen may still fail. A change in regimen may be necessary. However, before changing your regimen, your health care provider will order tests to confirm that your regimen is not effective (CD4 count, viral load test, and drug-resistance testing).

In general, your new treatment regimen should include two or more medications from two or more drug classes. To select new medications, you and your health care provider will review your medication history, past side effects from medications, and results of drug-resistance testing. Your health care provider may recommend a regimen that includes anti-HIV medications you have never taken before.

If you have already taken many of the FDA-approved anti-HIV medications, your health care provider may recommend a new medication currently being studied. You may be eligible to take part in a research study (clinical trial) using the new medication. Ask your health care provider about participating in a clinical trial or visit the Clinical Trials section of the AIDSinfo Web site at http://aidsinfo.nih.gov/clinicaltrials/.

How can I give my new regimen the best chance of success?

Before starting your new regimen, talk to your health care provider about things that can make adherence difficult, including:

• Possible side effects of the new medication.
• Lifestyle or personal issues that may prevent you from taking your medications as directed

Make a commitment to keep your medical appointments and adhere to your new regimen. Taking your anti-HIV medications every day as prescribed will give your new regimen the best chance to succeed. (See the Treatment Adherence and Following an HIV Treatment Regimen fact sheets.)

For More Information

Contact an AIDSinfo health information specialist at 1–800–448–0440 or visit http://aidsinfo.nih.gov. See your health care provider for medical advice.

This information is based on the U.S. Department of Health and Human Services' Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents (available at http://aidsinfo.nih.gov/Guidelines/).