Virologic Failure in HIV: An Updated Clinician’s Guide to Assessment and Management

By Jürgen Rockstroh, MD and David Wohl, MD

Though the prevalence of virologic failure (VF) in patients with HIV has decreased as newer antiretroviral (ART) regimens with higher genetic barriers to resistance and reduced toxicity have been approved, VF can still occur. VF may be due to patient, viral, or ART factors, and it is critical that clinicians determine the underlying cause before switching ART regimens so they can work with the patient to select the most appropriate regimen. Resistance will affect selection of subsequent regimens for patients experiencing VF, particularly among those with multidrug resistance (MDR). All patients experiencing VF should undergo resistance testing, and clinicians should engage in shared decision-making when selecting ART regimens, to ensure the patient can be adherent.  

Heavily treatment-experienced (HTE) patients with MDR have had few options specifically designed to supplement an optimized background regimen, but these options have expanded over the last several years, and there is hope that this small subset of patients will have even more options in the future. In this eHealth activity, Drs David Wohl and Jürgen Rockstroh discuss evaluation of VF, selection of subsequent regimens for patients experiencing VF, and recently approved and emerging options for HTE patients,  including how to create and simplify salvage regimens for these patients.

• Language: English
• Publisher: Integritas Communications
• Release date: Jun 10, 2022

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Faculty

Jürgen Rockstroh, MD

Professor of Medicine

Head of the HIV Outpatient Clinic

University of Bonn

Bonn, Germany

Jürgen Rockstroh, MD, is Professor of Medicine and Head of the HIV Outpatient Clinic at the University of Bonn in Germany. He earned his Doctor of Medicine degree from the Rheinische Friedrich-Wilhelms University of Bonn and completed his residency in the Department of Medicine at the University of Bonn. His department treats the world’s largest cohort of HIV-infected patients with hemophilia.

In addition to his clinical practice, Dr Rockstroh is involved in HIV research on antiretroviral therapy (ART), including new drug classes; the course of HIV disease in patients with hemophilia; and HIV and hepatitis co-infection. More recently, he has begun working on the impact of COVID-19 on HIV co-infection. He has been an investigator in multiple clinical trials of ART agents and treatments for HIV, hepatitis co-infection, and COVID-19.

From 2007 to 2011 he served as president of the German AIDS Society. Since 2009, he has been a member of the executive committee of the European AIDS Clinical Society (EACS), and from 2011 to 2020 was a member of the governing council of the International AIDS Society. He was chair of the National German AIDS Advisory Panel from  2011 to 2017 and of the EACS co-infection guidelines committee from 2008 to 2017. In 2015, Professor Rockstroh was elected chair of HIV in Europe (in 2019 renamed as EuroTEST), and in 2019-2020 was president of EACS.

The German Society for Infectious Diseases awarded Dr Rockstroh and his co-authors the prize in clinical infectious diseases in 2002 and the national AIDS research prize in 2005. Dr Rockstroh has authored or co-authored more than 700 publications in peer-reviewed journals and more than 100 book chapters.

David A. Wohl, MD

Professor of Medicine

Co-Principal Investigator, Global Infectious Disease Clinical Research Unit

Co-Director, Viral Hemorrhagic Fever Clinical Research Group and UNC Project Liberia

Institute for Global Health & Infectious Diseases

The University of North Carolina at Chapel Hill School of Medicine

Chapel Hill, North Carolina

Dr Wohl is a Professor of Medicine in the Division of Infectious Diseases at the University of North Carolina (UNC). He is co-Principal Investigator of the Global UNC Infectious Diseases Clinical Research Unit and Site Leader of its Chapel Hill research site.

Dr Wohl is a clinical scientist with a focus on emergent infectious diseases. He has spent more than 20 years leading research into the prevention and treatment of HIV and served 2 terms as a member of the US Department of Health and Human Services Antiretroviral Guidelines Panel.

Since 2014, he has been working continuously in Liberia, West Africa, conducting research with survivors of Ebola to learn about chronic complications and sexual transmission of this infection and establishing the UNC Project Liberia research platform at 2 locations in the country. He and