Exhaustion of treatment options is a challenge that can be delayed

An HIV infected person can possibly live a normal lifespan today, provided she or he takes highly active antiretroviral therapy and takes it perfectly. As pointed out by Sabin et al in this issue,1 even though new drugs are available each year, a noteworthy proportion of people are at risk of exhausting their treatment options. This proportion is only an imperfect surrogate of the presence of mutations giving rise to resistance to antiretrovirals. For an increasing number of patients, identifying a new regimen that could lower the HIV viraemia, increase the CD4 cell count, and prevent clinical progression is somewhat complicated. Looking at reasons why a current regimen is no longer working may help to make the available options clearer.

Suboptimal adherence to treatment is the most common and crucial reason for failing an antiretroviral regimen. Taking treatment at the correct …