9th Conference on Retroviruses and Opportunistic Infections Seattle, Washington - February 24 -February 28, 2002

Conf Retroviruses Opportunistic Infect 2002 Feb 24-28;9:abstract no. L7
Ann Collier
Univ. of Washington, Seattle

BACKGROUND: The high prevalence of patients with drug-resistant HIV underscores the importance of understanding the issues that lead to this condition, in order to optimize its management. Insufficient drug exposure to prevent emergence of resistant virus may result from the use of regimens with inadequate potency, and pharmacokinetics, adverse drug-drug interactions, poor adherence, or lack of penetration into viral reservoirs. Management approaches and treatment goals differ for patients with limited drug resistance compared with patients with multi-class resistant HIV. Maximizing viral suppression with a regimen that is well tolerated is a reasonable goal for patients with limited viral resistance. Achieving partial viral suppression with a goal of maintaining CD4⁺ T-lymphocyte counts and preventing opportunistic complications is a more realistic goal in many patients with highly resistant virus. Use of resistance testing, measurement of drug concentrations, and methods to assess and enhance adherence are important management tools, although the strength of data supporting their clinical utility varies. In patients with limited viral resistance, several approaches may be successful, including intensification of therapy or switching to regimens that include a new drug class. In patients with highly resistant virus, fewer treatment options have been demonstrated to result in long-term success. Regimens that include a new drug class, the entry inhibitors, have shown great promise but such compounds are not yet widely available. Use of second-generation non-nucleoside reverse transcriptase inhibitors, protease inhibitors with limited cross-resistance, and ritonavir-enhanced protease inhibitors are also promising approaches. Drugs directed against other viral or host targets are eagerly awaited. Other options for selected patients include short-term structured treatment interruption with the rationale of enhancing responses to salvage regimens, multi-drug rescue therapy, use of drugs which might impact viral fitness, and adjunctive therapies.

CONCLUSIONS: Individualizing the approach for patients with drug resistant virus will ensure therapy minimizes the downsides and maximizes the benefits. This difficult management dilemma challenges all HIV laboratory scientists, clinical researchers, treatment advocates, and care providers to continue the quest to improve therapy and access to therapy for all persons with HIV.

020224
L7

Copyright © 2002 - Foundation for Retrovirology and Human Health. Reproduction of this abstract (other than one copy for personal reference) must be cleared through the Foundation for Retrovirology and Human Health. Licensed (AIDSLINE) from National Library of Medicine.