HIV-positive patients who have been receiving long-term antiretroviral treatment are less likely to respond to subsequent rounds of treatment, according to a Review in the August issue of The Lancet Infectious Diseases.
Zelalem Temesgen (Mayo Clinic, Division of Infectious Diseases, Rochester, MN, USA) and colleagues looked at the management of such patients and found that highly active antiretroviral therapy (HAART), in which potent anti-HIV drugs are used in combination, has led to a significant decline in mortality and morbidity of people infected with HIV. However, a substantial amount of patients (about 50%) have virus, which has acquired resistance to antiretroviral drugs following long term use. This problem in turn has contributed to an increase in mortality among this population.
In their review, Temesgen and colleagues suggest a rationale for treating antiretroviral-experienced patients, with recommendations including: addressing existing problems of adherence, taking thorough patient histories and performing resistance tests on HIV from the patient. Using drugs from new antiretroviral classes that the patient has not taken before should improve outcomes, and even continuing a course of treatment that appears to be failing could still be beneficial in delaying the progression of the disease.