- We recommend accessing newer agents through
research trials, expanded access and named individual programmes.
- We suggest that consideration on an
individual basis should be given to whether inclusion of NRTIs with reduced
activity on genotypic testing will provide additional antiviral activity – this may well be the case where it is
difficult to construct a regimen with three fully active drugs including a
boosted PI (see previous section).
- We recommend against discontinuing or
- We recommend against adding a single, fully
active ARV because of the risk of further resistance.
- We recommend against the use of MVC to increase
the CD4 cell count when there is evidence for X4 or dual tropic virus.
- We recommend that in the context of triple class
failure and RAL/EVG selected integrase resistance, twice daily DTG should be
included as part of a new regimen where there is at least one fully active
agent in the background regimen.