Strategic selective treatment in highly pre-treated HIV patients harbouring multiply resistant viruses

We propose a new therapeutic strategy for heavily pre-treated patients with multidrug-resistant viruses. Our approach, strategic selective treatment, is based on the use of genotypic-driven antiretroviral treatments rapidly changed according to the emergence of new viral populations to achieve an ever-changing, sustained selective pressure that would allow a restriction of viral replication and the maintenance of CD4 cell blood levels. We evaluated strategic selective treatment in a 14 months pilot, prospective study in 34 patients. HIV-RNA levels were checked every 2 months and, in the case of a value greater than 10000 copies/ml, antiretroviral therapy was changed according to genotypic tests. Therapies were based on no more than four drugs.