Changing treatment:
second-line therapy and drug resistance

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This guide will help you make decisions about changing you HIV treament – because your combination has stopped working or because of side-effects. It tells you about why a combination can stop working, strategies for choosing a new combination, resistance tests, therapeutic drug monitoring, using more than 3 drugs, new drugs, drug recycling and treatment breaks.

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Full section index.

Summary – 10 key points.

Introduction

Including changes to this edition.

Resistance, cross-resistance and adherence.

About resistance & adherence and why these are closely related

What, why, how.

What is 'MDR' therapy? Why change treatment? Why viral load tests are important

What to do about a rising viral load.

If your viral load starts to rise after being undetectable, don't panic, but do take it seriously.

Why a combination can fail.

Was this related to prior resistance, adherence, drug absorption, or a combination of these reasons?

Important monitoring tests.

Viral load, resistance tests, therapeutic drug monitoring (TDM), getting these tests.

Choices for your next combination.

The combination you choose will depend on your previous drug history and your current test results.

Treatment strategies.

Using more drugs, using new drugs, using T-20, drug boosting & recycling, treatment interruptions, viral fitness.

Changing treatment to avoid side effects.

Many people change treatment either to avoid side effects or to have a therapy that is easier to follow.

Expanded access and experimental drugs.

Further information.

Glossary.

Disclaimer
Information in this guide is not intended to replace information from your doctor or other healthcare workers. Decisions relating to your treatment should always be taken in consultation with your doctor.

Authors
Written by Simon Collins and produced by HIV i-Base.
Drawings: Beth Higgins.

HIV information dates quickly. If you're reading after Summer 2009, please call in case an updated version is available. Not-for-profit copying is encouraged or call for additional free copies.

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This is the web edition of the i-Base guide Changing treatment: second-line therapy and drug resistance. This guide is available in UK clinics. You can order free printed copies or download a PDF version (396 Kb). There are also several translations.