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Is There Any Clinical Benefit to Staying on a Failing Regimen?

The accumulation of drug resistance after the failure of an anti-HIV drug combination is slower in patients who had previously experienced only moderate// CD4 cell losses, according to a study of patients failing treatment at a network of European hospitals.

However, the study also found that on average, patients who remained on a failing regimen lost 1.25 active drugs from the choice still available to them for every six months on failing treatment, highlighting the need for prompt treatment switches wherever possible.

Participants in the study also showed minimal declines in their CD4 cell counts.

The results are published in the March 30th edition of the journal AIDS.

The development of drug resistance after treatment failure has led to the strong recommendation in various national treatment guidelines that treatment should be switched as soon as possible after virological failure is detected, and that resistance testing should be used in order to select the successor regimen.

However, not all patients are able to assemble a drug combination that will contain three fully active drugs, and researchers connected with the EuroSIDA cohort study wanted to assess how quickly people on failing drug regimens might accumulate further drug resistance mutations if they did not switch treatment.

They carried out a retrospective study using stored plasma samples from participants in the EuroSIDA cohort. Selected for study were patients who had been on a virologically failing regimen for at least six months, and thereafter, had two resistance tests during the period when viral load was below 400 copies/mL and who had also remained on an unchanged regimen containing at least three antiretrovirals.

Prior to their current failing regimen, on average, patients had previously used five other drugs and virologically failed one or more drug classes. Regimens being used included NRTIs, NNRTIs, single
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