Reasons for change

Change

Toxicity or intolerance HIV
RNA suppressed below target

Change the offending drug (if discernible)

HIV RNA suppressed but still above target
And fewer than 8-16 weeks with therapy.

Change offending drug if discernible

HIV RNA above target, more than 8-16 weeks

Change entire regimen

Difficulty with adherence
HIV RNA suppressed below target, but adherence problems present

Change to simplified regimen with equal potency; substitute single drug if known

HIV RNA above target, more than 8-16 weeks with therapy.

Change to simplified regimen with equal potency substitute single drug if known.

HIV RNA above target, more than 8-16 weeks with therapy or prior successes.

Change entire regimen

Virologic failure adherence,
Failure to reach target viral load within adherence 8-16, weeks of therapy

Continue current regimen, assess consider intensification.

Failure to reach target viral load within 24-36 weeks of therapy

Change entire regime

Prior success but now confirmed drug faiture.

Change entire regime

Prior Regimen

New Regimen (Not listed in priority order)

2 NRTIs +

2 new NRTIs

Nelfinavir

RTV; IDV; or SQV + RTV; or NNRTI + RTV; or NNRTI ID**

Ritonavir

SQV + RTV**; NFV + NNRTI; or NFV + SQV

Indinavir

SQV + RTV; NFV + SQV

Saquinavir

RTV + SQV; OR NNRTI + IDV RTV + IDV

2 NRTIs + NNRTI

2 new NRTIs + a protease inhibitor

2 NRTIs

2 new NRTIs + a protease inhibitor

2 new NRTIs + RTV + SQV

1 new NRTI + 1 NNRTI + a protease inhibitor

2 protease inhibitors + NNRTI

1 NRTI

2 new NRTIs + a protease inhibitor

2 new NRTIs + NNRTI

1 new NRTI + 1 NNRTI + a protease inhibitor