| Abstract: | Second-line and rescue antiretrovirals regimens have a poor success record only 30-45% achieves viral suppression. This rate will be improved if salvage therapy is individualized with a better understanding what causes previous failures, establishing reasonable goals of therapy for the patient and speaking with him about the pros and the cons of the new regimens.Before deciding the change we must have available the first and the present HIV RNA levels, absolute CD4 T cell count and changes in these counts, prior antiretroviral therapies, resistance test, assessment of adherence to medications, and preparation of the patient for the implications of the new regimens. Carrying out drug salvage levels and the inhibitory quotient probably can be important.In patients on therapy with detectable but low (< 5,000 copies/ml) stable HIV RNA levels the risk of clinical or immunologic failure is low. Recent reports provide support for a conservative strategy, particularly for those patients with limited therapeutic options.In-patients who are failing their second regimen it is important to use at least two new susceptible drugs, with a high potency and using combinations that assure high drug levels. In this population treatment interruption as a strategy for managing drug resistance is in study.New therapies such as DAPD, tenofovir, TMC 120, lopinavir, tipranavir and T-20 offer significant promise for the treatment of drug-experienced patients. |
