• We recommend individuals with persistent viraemia and with limited options to construct a fully suppressive regimen are discussed/referred for expert advice (or through virtual clinic referral).
  • We recommend individuals with extensive drug resistance are switched to a new ART regimen containing at least two and preferably three fully active agents with at least one active PI/r such as DRV/r and one agent with a novel mechanism (an INI, MVC or enfuvirtide) with ETV as an option based on viral susceptibility.
  • We recommend individuals with extensive drug resistance including reduced darunavir susceptibility receive DTG as the INI.
  • 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 if the regimen includes three fully active drugs, including a boosted PI.
  • We recommend all individuals receive intensive adherence support at the start and at regular intervals to support them on their new ART combination.