Clinical case - “Highly treatment experienced”: Skilled doctors encountering advanced patients histories
Treatment-experienced patients are complex to manage: factors leading to previous treatment failures and toxicities, coupled with a longer duration of infection and the frequent coexistence of multiple morbidities make it challenging to achieve the desired outcome – an effective, durable, well-tolerated, compact and easy-to-take antiretroviral regimen.
Key issues for today’s prescribers making antiviral regimen choices are i) balancing potency within the context of a regimen that has at least a realistic prospect of durable adherence, ii) constructing a sufficiently potent regimen in patients with extensive resistance who are intolerant to boosted protease inhibitors (PI) iii) understanding how to exploit any residual activity of NRTIs (in the presence of genotypic resistance) within PI, and non-PI containing regimens and iv) managing drug-drug interactions inherent when treating other co-morbidities. The case(s) described will highlight common clinical scenarios associated with these difficult choices.
Saye Khoo, University of Liverpool, United Kingdom
Saye Khoo, MD, PhD, is Professor in the Department of Pharmacology at the University of Liverpool, and Honorary Consultant Physician in Infectious Diseases at the Royal Liverpool University Hospital. His research focuses on infection pharmacology, including optimising dosing for special populations and drug-drug interactions in the treatment and prevention of HIV and TB. He leads the international DolPHIN consortium studying safe and effective use of anti-retrovirals in pregnancy, and provides clinical leadership for Liverpool Drug Interactions programme (www.drug-interactions.org).
He is also Chief Investigator for the AGILE Phase I/II platform for SARS CoV2 therapies (www.agiletrial.net).