The best approach is to look for new anti-HIV drugs that have proven to be effective for HIV-positive people who have tried and failed other anti-HIV drugs in the past. Fortunately, a number of drugs have been approved in recent years specifically for people with multiple-drug-resistant HIV.
For patients who have used other protease inhibitors in the past, Prezista (darunavir) and Aptivus (tipranavir) have shown promising results in clinical trials.
Entry inhibitors, including the injectable drug Fuzeon (enfuvirtide) and the oral medication Selzentry (maraviroc), may also have a great deal to offer HIV-positive people with limited treatment options. Because these medications target HIV differently than other drug classes, such as protease inhibitors and non-nucleoside reverse transcriptase inhibitors used in initial drug combinations, many treatment-experienced people will likely benefit from their use.
For these drugs to be maximally effective, it is best to combine them with other drugs that your virus is most sensitive to, which may mean reusing antiretrovirals you've tried in the past. You should use the results of drug-resistance testing to determine which drugs you're most likely to benefit from. If you can pull together a handful of drugs that your virus is only "partly" or "moderately" resistant to—especially if you do have one or two new drugs to combine with them—you may be able to reduce your viral load to low levels and keep it there for a prolonged period of time.
Don't forget to keep your eyes open for experimental drugs that are proving to be effective for people who have become resistant to many or all of the currently available options (see the last section of this lesson).
Another option is multi-drug therapy, a strategy that calls for the combination of up to nine anti-HIV drugs. No matter how many drugs and drug combinations a patient has taken, the theory goes, it is unlikely that any one virus in the body will be resistant to all of the drugs in a complex, multi-drug regimen. This might involve a drug regimen containing up to three protease inhibitors and/or two non-nucleoside reverse transcriptase inhibitors. These types of regimens have been found to be useful in clinical trials, but definitely have their drawbacks—they usually mean multiple daily doses, may be associated with serious side effects, and possibly cause a number of drug-drug interactions.
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