Factors to consider

People who are selecting a subsequent regimen should take into account many of the same factors as patients starting treatment for the first time. These include:

  • Ability to maintain good adherence.
  • Current and lowest-ever (nadir) CD4 cell count.
  • Viral load.
  • Disease symptoms and clinical progression.
  • Regimen convenience and dosing regimens.
  • Treatment history and drug resistance.
  • Potential interactions with other medications.
  • Central nervous system penetration.
  • Short-term side-effects and long-term drug toxicities.
  • Pregnancy.
  • Co-existing conditions.

However, for patients who have experienced one or more treatment failures, some considerations will have more weight. In many cases, people choosing a subsequent regimen will have more advanced HIV disease, with a higher viral load, lower CD4 cell count and more symptoms of disease progression than someone first starting treatment. This is especially true of those with extensive drug resistance who have had trouble constructing a fully suppressive regimen.

Instead of anticipating and avoiding side-effects, treatment-experienced patients may be dealing with existing symptoms, including mitochondrial and metabolic complications. In some cases, long-term side-effects such as peripheral neuropathy, lipoatrophy and blood fat elevations may have progressed for some time and may be quite severe. For further information, see Side-effects and toxicities.

If changing treatment because of virological failure, treatment history and existing drug resistance are likely to be the most important considerations in selecting a new regimen.  

Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.