Optimizing Antiretroviral Therapy in Treatment-Experienced Patients Living with HIV: A Critical Review of Switch and Simplification Strategies. An Opinion of the HIV Practice and Research Network of the American College of Clinical Pharmacy

Abstract

Simplifying or switching antiretroviral therapy (ART) in treatment-experienced people living with HIV (PLWH) may improve adherence, tolerability, toxicities, and/or drug–drug interactions. The purpose of this review is to critically evaluate the literature for efficacy and safety associated with switching or simplifying ART in treatment-experienced PLWH. A systematic literature search using MEDLINE was performed from January 1, 2010 to April 30, 2018. References within articles of interest, the Department of Health and Human Services guidelines, and conference abstracts were also reviewed. Switch/simplification strategies were categorized as those supported by high-level clinical evidence and those with emerging data. Rates of virologic suppression were noninferior for several switch/simplification strategies when compared to baseline ART. Potential for reducing adverse events was also seen. Additional evidence for some strategies, including most 2-drug regimens, is needed before they can be recommended.

Personalizing prevention: Advances in pharmacotherapy for HIV prevention

“…Simplification of ART in treatment-experienced patients with complex regimens have demonstrated improved patient outcomes and reduced HIV transmission, highlighting its role in TasP. 19…”

“…Drug resistance testing will guide ARV selection, but efforts should be made to provide patients with the lowest pill burden and frequency of dosing as possible to help with adherence. Simplification of ART in treatment‐experienced patients with complex regimens have demonstrated improved patient outcomes and reduced HIV transmission, highlighting its role in TasP 19 …”

Evaluation of the Efficacy and Tolerability of Dolutegravir Plus Lamivudine as a Switch Strategy in Treatment-experienced HIV-infected Patients

“…ART has been associated with a standard three-drug regimen including two nucleoside reverse transcriptase inhibitors (NRTIs) and one other drug from either the non-nucleoside reverse transcriptase inhibitor (NNRTI), protease inhibitor (PI), or integrase strand transfer inhibitor (INSTI) classes. In order to achieve and maintain viral suppression while reducing cumulative drug toxicities and cost, and improve long-term drug adherence and convenience, strategies with less than triple therapy have been explored including dual therapy and monotherapy using the newest potent antiretrovirals [4], and several coformulations have also been developed to make into once-daily single-tablet regimen.…”

RuSIDA: the online resource for the collection, storage and analysis of epidemiologicel, demographic and clinical laboratory data of patients

“…В рамках борьбы с ВИЧ-инфекцией активно проводятся клинические испытания новых антиретровирусных препаратов [3][4][5] и вакцин [6], изучаются побочные эффекты антиретровирусной терапии [7,8], исследуются пути оптимизации схем АРТ [9][10][11] и различные стратегии лечения [12,13], значительное внимание уделяется вопросу межлекарственных взаимодействий [14][15][16] и приверженности пациентов [17]. Каждое из таких исследований невозможно без систематизированного сбора и последующего многопланового анализа многочисленных клинико-эпидемиологических данных пациентов.…”