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Massive Change in U.S. Treatment Guidelines

January 2010

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Treatment-Experienced Patients

According to results from clinical trials, the majority of HIV-positive people benefit from anti-HIV therapy. What's more, in some studies participants are able to prolong their suppression of HIV for three to seven years, depending on the study. However, sometimes anti-HIV therapy can fail. The panel recommends that the reasons for treatment failure be investigated and that treatment failure should be treated "aggressively."

Treatment failure can occur for many reasons. There are some issues that may predispose people to an increased risk for treatment failure even before they start therapy, such as:

  • being infected with a strain of drug-resistant HIV
  • having a high viral load before starting therapy
  • having a very low CD4+ cell count prior to starting therapy
  • having had a diagnosis of AIDS
  • co-existing health problems, such as depression and/or active substance use

There are further issues that may play a role in treatment failure after people start therapy, such as:

  • incomplete adherence and missing clinic appointments
  • experiencing drug side effects
  • the presence of less-than-normal concentrations of anti-HIV drugs in the blood, caused by poor absorption or drug interactions
  • the use of weak regimens
  • insufficient physician experience treating HIV infection
  • other, unknown reasons

When making decisions about therapy for treatment-experienced patients, the panel emphasizes the importance of resistance testing, reviewing treatment history and using active anti-HIV drugs in a new regimen. The panel provides extensive and helpful tips for doctors who care for treatment-experienced patients.

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This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication TreatmentUpdate. Visit CATIE's Web site to find out more about their activities, publications and services.
 
See Also
Read the Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents
More News and Analysis on HIV Treatment Guidelines


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