New therapeutic options in protracted hiv-infected patients with virological failure

Once patients have a triple class virological failure, their treatment options are limited and there is an increased risk of death. In order to construct active treatment regimens, new potent antiretroviral agents are available for these patients. The virological target in patients with treatment failure is now plasma HIV RNA level below 50 copies/ml when 2 or more potent drugs are identified. If at least two active drugs cannot be identified, the current regimen should be maintained until new drugs become available, assuming that there is an immunological and clinical stability, in order to avoid the use of a single-active drug that usually leads to rapid development of resistance, further limiting the future treatment options. In this article, the current state of knowledge about these new agents available and the guidelines of main societies are reviewed.