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  • Title: Salvage therapy.
    Author: Gulick RM.
    Journal: AIDS Clin Care; 1999 Sep; 11(9):71-3, 77-8. PubMed ID: 11366502.
    Abstract:
    The current guidelines for HIV therapy are two nucleoside analog reverse transcriptase inhibitors (NRTIs) in combination with one or two protease inhibitors (PIs) or a non-nucleoside reverse transcriptase inhibitor (NNRTI). These guidelines are based on clinical trials geared toward reducing viral loads to undetectable levels. In 10 to 20 percent of patients, however, such a reduction in viral load will not be accomplished. Virologic failure rates observed in cohort studies in the United States and Europe have reached rates as high as 60 percent after a year of treatment. Some predictors of treatment failure include higher viral load baselines, lower baseline CD4-cell counts, and failure to initiate treatment with an NNRTI. Clearly, better approaches to salvage therapy are needed. Studies include the evaluation of effectiveness of switching treatments from one PI to another, newer drugs, and multidrug regimens. Two tables, involving current guidelines for and major prospective studies on salvage therapy, are provided. In addition, the use of resistance testing in monitoring salvage therapy is discussed.
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