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| HIV / AIDS INFO :: TREATMENT FAILURE |
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 Virologic failure
Immunologic failure
Clinical failure
Treatment Options
Virologic failure refers specifically to incomplete (or lack of) HIV RNA response:
Incomplete virologic response:
After initiation of Antiretroviral therapy in a treatment-naïve patient, not achieving
- 1 log10 copies/mL, HIV RNA decrease at 1– 4 weeks or
- HIV RNA <400 copies/mL by 24 weeks or
- HIV RNA <50 copies/mL by 48 weeks
Virologic rebound:
After virologic suppression, repeated detection of viremia.
There is no consensus on the optimal time to change therapy for low-level viremia. The most aggressive approach would be to change for any repeated, detectable viremia (e.g., two consecutive HIV RNA >400 copies/mL after suppression to <400 copies/mL in a patient taking the regimen).
Isolated episodes of viremia (“blips”, e.g. single levels of 50–1,000 copies/mL) usually are not associated with subsequent virologic failure, but rebound to higher viral load levels or more frequent episodes of viremia increase the risk of failure.
Immunologic failure:
Failure to increase 25–50 cells/mm3 above the baseline CD4 cell count over the
first year of therapy or experiencing a decrease to below the baseline CD4 cell count on therapy. Mean
increases in CD4 cell counts in treatment-naïve patients with initial antiretroviral regimens are approximately 150 cells/mm3 over the first year.
Clinical failure:
Occurrence or recurrence of HIV-related events (after at least 3 months on an antiretroviral regimen), excluding immune reconstitution syndromes.
Treatment Options Following Virologic Failure on Initial Recommended Therapy Regimens
| Regimen Class | Initial Regimen | Recommended Change |
| NNRTI | 2 nucleosides + NNRTI | 2 nucleosides (based on resistance testing) + PI (with or without low-dose ritonavir) |
| PI | 2 nucleosides + PI (with or without low-dose ritonavir) | 2 nucleosides (based on resistance testing) + NNRTI |
| Triple nucleosides | 3 nucleosides | 2 nucleosides (based on resistance testing) + NNRTI or PI (with or without low-dose ritonavir) _ NNRTI + PI (with or without low-dose ritonavir)
Nucleoside(s) (based on resistance testing) + NNRTI + PI (with or without low-dose Ritonavir) |
Adapted from DHHS guidelines, April 7, 2005
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