Salvage therapy.

Abstract

Salvage therapy is an approach taken when previous anti-HIV treatments fail to achieve desired goals, which include undetectable viral load, CD4 cell levels above 200 cells/mm3, and the prevention of HIV disease progression. It is one of the most difficult situations to face as a patient, and one of the most problematic challenges for health-care providers. Though sometimes euphemistically referred to as "management of treatment-experienced patients," many HIV positive people, having already exhausted the benefits of at least a couple of drug combinations, think of their next regimen as salvage or "rescue" therapy. A few physicians argue that due to cross-resistance among different drugs within the same class, people with HIV infection have only one good shot at treating it, and that any treatment regimen beyond the first is therefore salvage therapy. Others see salvage therapy as literally the end of the line--when an individual's HIV has developed extensive resistance to all currently available treatments. But most providers consider salvage therapy to be somewhere in between these extremes. Understanding that the term can refer to different treatment situations is important. Nevertheless, most of the information in this article will be relevant for anyone changing a drug regimen, no matter where that person is on the treatment path.