Contemporary Management of HIV 2021: Heavily Treatment–Experienced Patients—Audio Recap, Part 1

In this series of 3 episodes, Geeta Gupta, MD, discusses strategies for optimizing ART in heavily treatment–experienced patients with HIV, including management of virologic failure and switching ART in virologically suppressed patients with underlying resistance. The 3 episodes will include analyses from:

• BENCHMRK, which demonstrated that the number of active drugs predicts outcomes in treatment-experienced patients
• TMB-301, a study that added the monoclonal antibody ibalizumab in pretreated patients with multidrug-resistant HIV and demonstrated significant decreases in HIV-1 RNA
• BRIGHTE, which showed that the addition of fostemsavir in heavily treatment–experienced patients with HIV led to a significant decrease in HIV-1 RNA
• VIKING-3, a study that demonstrated the addition of DTG dosed BID in INI-resistant patients was effective in decreasing HIV-1 RNA
• SWITCHMRK, a study that showed underlying resistance matters when deciding to switch regimens in a treatment-experienced, virologically suppressed patient, especially when switching to a regimen with a low barrier to resistance
• DAWNING, a study that demonstrated that DTG, when added to 2 NRTIs, was superior to RTV-boosted LPV in patients with virologic failure on an NNRTI plus 2 NRTIs
• BRAAVE, which evaluated safety and efficacy of switching to BIC/FTC/TAF in Black patients virologically suppressed on 2 NRTIs plus a third agent

In addition, Dr. Gupta reviews current DHHS ART guideline recommendations related to managing virologic failure, including drug resistance testing and drug selection, as well as switching recommendations in patients with viral suppression and underlying drug resistance.