There’s way too much in the guidelines on these topics to distill here. Remember, however, that the guidelines are written to help guide medical providers. Although they are written clearly and straightforwardly, the language can be technical. See the glossary on the following page as well as the one at clinicalinfo.hiv.gov/en/glossary.
Still, how about a summary of the treatment-experience part of the guidelines? The summary paragraph for the DHHS guidelines section on “Management of the Treatment-Experienced Patient” serves as a good overview of what you need to know, listed here sentence by sentence:
The goal of treatment for ART-experienced patients with virologic failure is to establish virologic suppression.
The management of ART-experienced patients with virologic failure often requires expert advice to construct virologically suppressive regimens.
Before modifying a regimen, it is critical to carefully evaluate the potential cause(s) of virologic failure, including incomplete adherence, poor tolerability, and drug-drug and drug-food interactions, as well as to review HIV RNA and CD4 count changes over time, complete treatment history, and current and previous drug-resistance test results.
If HIV RNA suppression is not possible with currently approved agents, consider the use of investigational agents through participation in clinical trials or expanded/single-patient access programs.
If virologic suppression is still not achievable, the choice of regimens should focus on minimizing toxicity and preserving treatment options while maintaining CD4 counts to delay clinical progression.
And if your eyes haven’t glazed over yet, there’s a huge section on drug-drug interactions you might be interested in. The biggest problems for HIV meds are covered there.
Get more HIV guidelines, from the International AIDS Society-USA, at iasusa.org.