Switching antiretroviral therapy:Why, when, and how

摘要

Once antiretroviral therapy (ART) is initiated, patients generally remain on medications indefinitely A switch in the antiretroviral (ARV) regimen is often necessary because of both acute and chronic toxicities, concomitant clinical conditions, and development of virologic failure The approach to patients who need to switch ART will differ depending on several issues, including the reason for change, the amount of previous ART experience, and the available treatment options. For example, when patients develop an adverse effect to a drug during their first ARV regimen, effective treatment may be easily accomplished by substituting another agent for the offending drug in the regimen. At the opposite end of the spectrum are patients with advanced HIV disease who have experienced toxicities, virologic failure,and drug resistance during multiple past treatment regimens and thus require a new treatment regimen. This article reviews these circumstances and provides clinical evidence and strategies for switching ART.