[Salvage therapy for HIV infection]

Area of Science:

• Infectious Diseases
• Virology
• Pharmacology

Context:

• Advances in combination antiretroviral therapy (cART) have significantly improved outcomes for HIV-1 infection.
• Viral suppression rates one year post-treatment initiation have increased, with a mean duration of first-line cART exceeding 24 months.
• Second or third-line cART regimens can achieve long-term viral suppression in many patients with treatment failure.

Purpose:

• To review current strategies for managing HIV-1 infection, particularly in cases of multidrug resistance.
• To outline challenges and therapeutic options for patients with resistance to three or more antiretroviral drug classes.
• To discuss the optimization of clinical prognosis and disease progression delay in difficult-to-treat HIV-1 cases.

Summary:

• While standard HIV therapy is highly effective, managing patients with extensive drug resistance (three or more drug classes) presents significant challenges.
• Therapeutic options for multidrug-resistant HIV include regimen intensification, maintaining partially effective treatments, temporary interruptions, or careful use of novel/investigational agents.
• Newer treatment sequences should ideally incorporate at least two new drugs to maximize efficacy.
• Long-term viral suppression is often unattainable in these complex cases; the focus shifts to optimizing clinical outcomes and delaying HIV progression.

Impact:

• Highlights the need for individualized treatment approaches in complex HIV-1 cases.
• Emphasizes the importance of strategic drug sequencing to preserve future treatment options.
• Underscores the goal of maximizing quality of life and delaying disease progression when complete viral suppression is not feasible.