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Modifying HIV antiretroviral therapy regimens

John G Bartlett, MD
Section Editor
Martin S Hirsch, MD
Deputy Editor
Jennifer Mitty, MD, MPH


Potent antiretroviral therapy (ART) has resulted in substantial reductions in mortality, progression to AIDS, opportunistic infections (OIs), and hospitalizations, particularly among those who achieve viral suppression [1,2]. Viral suppression is also associated with decreased morbidity and mortality related to other comorbidities (eg, cardiovascular disease, liver disease, and nephropathy) and decreased HIV transmission to uninfected persons [3,4]. For these reasons, the 2012 HIV treatment guidelines from the United States Department of Health and Human Services (DHHS) and the International Antiviral Society (IAS)-USA panels now recommend ART for all HIV-infected patients, regardless of CD4 cell count [3,4]. (See "When to initiate antiretroviral therapy in HIV-infected patients".)

However, the challenges of lifelong therapy include drug toxicity, the emergence of viral drug resistance, adverse drug interactions, high cost and the inconvenience of taking medications on a daily basis.

Clinicians need to continually assess the patient for adverse events, toxicities, and adherence while on HIV therapy. This topic will address the evaluation of the patient with indications for treatment modification. The medications discussed in this topic and their classes and abbreviations are shown in the table (table 1).

Initiation of ART regimens in naive patients, the use of ART to treat acute HIV, and major clinical trials of various regimens are discussed separately. (See "Selecting antiretroviral regimens for the treatment-naïve HIV-infected patient" and "When to initiate antiretroviral therapy in HIV-infected patients" and "Drug resistance testing in the clinical management of HIV infection" and "Clinical trials of HIV antiretroviral therapy: CCR5 antagonists" and "Clinical trials of HIV antiretroviral therapy: Integrase inhibitors" and "Clinical trials of HIV antiretroviral therapy: Protease inhibitors" and "Clinical trials of HIV antiretroviral therapy: Non-nucleoside reverse transcriptase inhibitors" and "Clinical trials of HIV antiretroviral therapy: Protease inhibitors versus non-nucleoside reverse transcriptase inhibitors".)


There are several indications for changing the antiretroviral regimen:


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Literature review current through: Sep 2016. | This topic last updated: May 22, 2015.
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