What to do in HIV Patients on a Failing Regimen With Limited Therapeutic Options?

Current HIV treatment guidelines recommendchanging to a more powerful regimen in case of virologicfailure. Nevertheless, patients with no fullyactive treatment options left are often kept on a failingregimen because switching would burn the few drugsstill active. Some drugs in the failing regimen maycontinue to have some antiviral activity, and cessationof therapy may be harmful. However, antiretroviraltherapy that is not fully suppressive is prone to furtheraccumulation of drug resistance in HIV. Therefore thedilemma arises: i) do we need to change anyway,despite not having an optimal rescue therapy, riskingalso blowing up the next line therapy; ii) do we stayon the current regimen, hoping that further accumulationof drug resistance will be limited; or iii) do weneed an entirely new strategy, picking a suboptimalmaintenance regimen with less selective pressure fornew drug resistance mutations?