Maximizing treatment outcome: key considerations for antiretroviral-experienced patients

Managing antiretroviral-experienced patients presents a significant challenge to the clinician, requiring not only individualized patient care and regimen selection but also knowledge of the patient's antiretroviral history and disease status and the estimated availability of novel antiretrovirals. The clinician's thorough understanding of these interrelated factors and their degree of influence is essential for maximizing treatment outcomes. It is important to consider patient adherence and tolerance of previous antiretrovirals when deciding on regimens subsequent to treatment failure. Resistance testing will help select "active" antiretrovirals that can be combined to develop the most potent regimen. In cases where resistance testing indicates little or no antiretroviral activity, the clinician must consider the individual risks and benefits of the continued use of a partially active regimen. The optimal timing for the introduction of new and soon-to-be-available antiretroviral agents must also be taken into consideration in order to maximize their efficacy.