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Go undetectable and beyond through comprehensive HIV treatment

In this video, HIV specialists discuss what factors may predict success in HIV care and how they can help providers create an appropriate therapeutic plan for their patients.

People featured are compensated by Gilead.

View transcript below.

Factors that predict success in HIV treatment include selection of the appropriate treatment for your patients, adherence to the prescribed regimen, and retention in care.

DERRICK BUTLER, MD: So, I have another question in terms of your practices. What have you found to be the predictors of virologic success in your patients?

CYNTHIA RIVERA, MD: It’s really about two things: how well the patient understands the importance of taking the medicine every day, as well as the regimen itself. So, really, as we get to know our patients, we do things like get our labs and see what the viral load is, how high is the viral load—maybe it’ll take a little bit longer to get our viral loads undetectable with higher viral loads, how well can the patient tolerate the regimen and assure that this will be something they’ll be able to take every day without any interruptions. 

LEANDRO MENA, MD: I think an important factor in building a successful therapeutic plan is really work with the patient, understanding the patient’s life, schedules. I mean, sometimes we assume. We, in life, have routines, we tend to do things at certain times, but when I talk to many of my patients, I ask, you know, tell me one thing you do every day around the same time; there’s nothing. So how do you integrate this into their regular life and how do you help them to build and need for at least this one thing, you have to take every day or at the same time? So, you want to make sure that whatever regimen you develop for the patient is something that fits their lifestyle. 

DERRICK BUTLER, MD: If the patient is starting with a low baseline viremia at onset, they’re more likely to reach undetectable levels. And also patients on a high-potency antiretroviral regimen should be able to reach that treatment goal also. I think, too, really, getting the patient to be on a regimen that actually adheres to their lifestyle, that actually fits into their daily activities so that they can remain adherent to their medications, which we know is a key to reaching virologic suppression. And, of course, that regimen being tolerable for the patient to take too.

Taking a comprehensive approach to therapy can be a step toward setting up your patients for long-term treatment success

The US Department of Health and Human Services (DHHS) guidelines recommend the use of a complete triple therapy based on a dual nucleoside reverse transcriptase inhibitor (NRTI) plus an integrase strand transfer inhibitor (INSTI) for treatment initiation.1

Starting in 2009, DHHS began recommending: 

to achieve and maintain virologic
suppression for treatment-naïve patients1,2

Consider these treatment attributes that can contribute to comprehensive HIV care

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Rapidly achieves and maintains durable viral suppression

According to the DHHS guidelines, the key goal of antiretroviral therapy (ART) is to achieve and maintain durable viral suppression. After initiation of effective ART, viral load reduction to below limits of assay detection usually occurs within the first 12 to 24 weeks of therapy.1

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Has a high barrier to resistance

Resistance barriers for antiretrovirals vary from low to high, based on the interplay among key contributing factors.1

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Provides a safety and tolerability profile that supports aging with HIV

The safety and tolerability profiles of ART are incredibly important factors to consider when choosing a comprehensive therapy. Providers should consider comprehensive HIV care that can support many stages of life.1

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Offers simple administration that aligns with your patients’ needs

Simple administration may help with adherence, which can impact viral suppression.1

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Rigorously evaluated in diverse patient populations (age, sex, race)

A rigorously evaluated treatment may help you make decisions appropriate for the diverse patient groups you see in your practice.1,3

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Empowers providers to initiate treatment ASAP

ART should be initiated as soon as possible in all patients living with HIV, regardless of CD4 cell count.1

Consider whether your treatment approach sets up patients for long-term treatment success.

References:

  1. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. Department of Health and Human Services. Updated May 26, 2023. Accessed July 24, 2023. https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/guidelines-adult-adolescent-arv.pdf
  2. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Updated November 3, 2009; Accessed November 8, 2021.
  3. US Food & Drug Administration. Clinical trial diversity. Updated November 19, 2021. Accessed January 12, 2022. https://www.fda.gov/consumers/minority-health-and-health-equity-resources/clinical-trial-diversity