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Virologic Failure in HIV

An Updated Clinician’s Guide to Assessment and Management

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Clinical Practice Guidelines

European AIDS Clinical Society.

EACS Guidelines 2021; v11.0; October 2021.

Human immunodeficiency virus drug resistance: 2018 recommendations of the International Antiviral Society-USA Panel.

Günthard HF, Calvez V, Paredes R, et al. Clin Infect Dis. 2019;68(2):177-187.

Guidelines for the use of antiretroviral agents in adults and adolescents living with HIV.

US Department of Health and Human Services

Clinician Resources

HIV resistance assays.

New York State Department of Health AIDS Institute.

HIV Drug Resistance Database.

Stanford University.

HIV drug resistance.

World Health Organization.

Patient and Caregiver Resources

AIDSMap Resources

NAM Publications

Resources for persons living with HIV

Centers for Disease Control and Prevention

HIV resources

National Institutes of Health

Suggested Readings

Dolutegravir versus ritonavir-boosted lopinavir both with dual nucleoside reverse transcriptase inhibitor therapy in adults with HIV-1 infection in whom first-line therapy has failed (DAWNING): an open-label, non-inferiority, phase 3b trial.

Aboud M, Kaplan R, Lombaard J, et al. Lancet Infect Dis. 2019;19(3):253-264.

Real-life experience with bictegravir/emtricitabine/tenofovir alafenamide in a large reference clinical centre.

Ambrosioni J, Rojas Liévano J, Berrocal L, et al. J Antimicrob Chemother. 2022;77(4):1133-1139.

Substantial decline in heavily treated therapy-experienced persons with HIV with limited antiretroviral treatment options.

Bajema KL, Nance RM, Delaney JAC, et al; Centers for AIDS Research Clinical Network of Integrated Systems (CNICS). AIDS. 2020;34(14):2051-2059.

Ritonavir-boosted lopinavir plus nucleoside or nucleotide reverse transcriptase inhibitors versus ritonavir-boosted lopinavir plus raltegravir for treatment of HIV-1 infection in adults with virological failure of a standard first-line ART regimen (SECOND-LINE): a randomised, open-label, non-inferiority study.

Boyd MA, Kumarasamy N, Moore CL, et al; SECOND-LINE Study Group. Lancet. 2013;381(9883):2091-2099.

The management of treatment-experienced HIV patients (including virologic failure and switches).

Cutrell J, Jodlowski T, Bedimo R. Ther Adv Infectious Dis. 2020;7:2049936120901395.

Lenacapavir: a first-in-class HIV-1 capsid inhibitor.

Dvory-Sobol H, Shaik N, Callebaut C, Rhee MS. Curr Opin HIV AIDS. 2022;17(1):15-21.

Phase 3 study of ibalizumab for multidrug-resistant HIV-1.

Emu B, Fessel J, Schrader S, et al. N Engl J Med. 2018;379(7):645-654.

Safety and efficacy of the HIV-1 attachment inhibitor prodrug fostemsavir in heavily treatment-experienced individuals: week 96 results of the phase 3 BRIGHTE study.

Lataillade M, Lalezari JP, Kozal M, et al. Lancet HIV. 2020;7(11):e740-e751.

Real life use of dolutegravir doravirine dual regimen in experienced elderly PLWH with multiple comorbidities and on polypharmacy: A retrospective analysis.

Mazzitelli M, Sasset L, Leoni D, Putaggio C, Cattelan AM. Medicine (Baltimore). 2021;100(52):e28488.

Long-acting lenacapavir in people with multidrug resistant HIV-1: week 52 results.

Ogbuagu O, Segal-Maurer S, Brinson C, et al. Presented at: Conference on Retroviruses and Opportunistic Infections; February 12-16, 2022; virtual conference. Abstract 491.

Potent antiviral activity of lenacapavir in phase 2/3 in heavily ART-experienced PWH.

Segal-Maurer S, Castagna A, Berhe M, et al.  CROI. March 6-10, 2021; Virtual Conference. Abstract 127.

The M184V mutation in HIV-1 reverse transcriptase reduces the restoration of wild-type replication by attenuated viruses.

Wei X, Liang C, Götte M, Wainberg MA. AIDS. 2002;16(18):2391-2398.

Efficacy and safety of dolutegravir plus boosted-darunavir dual therapy among highly treatment-experienced patients.

Vizcarra P, Fontecha M, Monsalvo M, Vivancos MJ, Rojo A, Casado JL. Antivir Ther. 2019;24(6):467-471.

Virologic Failure in HIV

An Updated Clinician’s Guide to Assessment and Management

Relevant Resources

PrEP for Your Patients’ Needs

The PCPs Role in Preventing HIV

Value-Based HIV Formularies

Optimizing Use of Clinical Evidence & Pharmacoeconomic Models in Managed Care

Hepatitis C is Curable

Got it? Treat it!

Real-World Issues in HIV Prevention & Treatment

The Critical Role of the Community Pharmacist


Bringing Local Communities Together to Eliminate Coinfection Through Knowledge and Partnerships.

Evolving Models of HIV Care

Volume 1: Rapid ART Initiation: A New Addition to the HIV-Care Tool Box

Updates in HCV Screening and Treatment

Key Issues Impacting OB/GYN Practice

Clinical Issues in Chronic Liver Disease

Hot Topics in HBV, HCV, and NASH

Evolving Models of HIV Care

Volume II: Expanding Evidence for the Role of Rapid ART Initiation in HIV Practice

Assessing Your Patients for HCV and HIV

Why It Matters in OB/GYN Practice Today

HIV as a Chronic Disease

A Treater’s Guide to Optimizing Care in the Aging Patient with Comorbidities

The Pursuit of Hepatitis C Elimination

How the Pharmacist Can Make a Difference

Trends in Infectious Diseases: Updates on Treatment & Prevention Strategies for HIV and HCV

Understanding the Growing Syndemic — Opioids, HCV, and HIV

Stepping Up to the Challenge

The PCP’s Role in HCV Elimination

The Changing Landscape of HIV Prevention

What the Pharmacist Needs to Know about PrEP

Evolving Models of HIV Care (Volume 3)

The Rapid ART Standard of Care: From Evidence to Healthcare Equity

HIV Updates for Pharmacy Practice

Maximizing Your Role to Impact Patient Outcomes


Building Bridges to Reach People Who Inject Drugs With the Goal to Eliminate HCV

Case Challenges in HIV Medicine

Benefits, Barriers, & Best Practices in an Advancing Field

Challenges and Opportunities in HIV

Practical Solutions Across the Spectrum of Care

Expanding HIV Prevention in Colorado—and Nationwide

A PEP/PrEP Training Guide for Pharmacists

Treating Hepatitis C in the Primary Care Setting

A Critical Step Toward HCV Elimination

Honing Clinical Skills in HIV Treatment

Considering the Patient, the Provider, and the Science

Hot Topics in HCV

A Multidisciplinary Online Mini-Curriculum

Clinical Issues in COVID-19

Debates and Discussions about Monoclonal Antibody Therapies

Minimizing Patient Risks From COVID-19

An Update on Monoclonal Antibody Therapies

Treating Hepatitis C in the Primary Care Setting

Establishing Clinical Readiness Through Mentored Learning

Clinical Updates in COVID-19

Recent Developments in Anti-SARS-CoV-2 Monoclonal Antibodies for Treatment

Monoclonal Antibodies for COVID-19

An Update on Best Practices

Monoclonal Antibodies for COVID-19

New Avenues to Pre-Exposure Prophylaxis

Applying HIV Advances in Practice

What the Pharmacist Needs to Know

Buffing Up on New and Emerging ART

A Look at the Changing HIV Playing Field

Pharmacy PrEP Education

A “How To” Series Spanning Policy to Practice


Building Bridges to Reach People who Inject Drugs with the Goal of Employing PrEP for HIV Prevention

Long-Acting Injectable PrEP:

Bringing HIV Prevention to a New Level

PrEParing to End the Epidemic

Optimizing HIV Prevention in Primary Care

A Call to Action

Monoclonal Antibodies for the Prevention and Treatment of COVID-19

Answers to Everyday Practice Challenges in HIV Medicine

A Phone-a-Friend CME Series – Volume 2

What’s New in the Management of COVID-19

Incorporating New Data and Updated Guidelines Into Daily Practice