• 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 interrupting ART.
  • 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.