Reasons for changing treatment
There are different reasons why you may need to change the combination of anti-HIV drugs you are taking. It could be that the side effects are too severe, in which case you and your doctor would want to look at changing to a combination that you can tolerate more.

The anti-HIV drugs you are taking may have stopped working properly. If this happened you and your doctor may notice your viral load starting to rise as the effect of the drugs on your HIV weakens. In this situation your doctor would want to perform a resistance test to check to see if your HIV has become resistant to one or more of the drugs you are taking. If this is the case then the resistance test would also be able to show your doctor which other anti-HIV drugs would be effective despite resistance to the ones you are currently taking. You and your doctor would then decide which new combination to change to.

It may be the case that the combination of drugs you are taking involves more pills per day than a newer and more convenient combination that has been developed. In this case, even though the anti-HIV drugs you are currently taking are still effective, you may want to consider changing to a combination with less pills or one that means you need to take them less often each day.

Whatever the reason for changing treatment, remember that you should never stop taking the anti-HIV drugs you are currently taking without discussion with your HIV doctor. If you do then you could be putting yourself at risk of developing resistance to these drugs.

"My first anti-HIV combination lowered my viral load to undetectable, and doubled my CD4 count. I also coped well with taking doses on time. Apart from a little nausea occasionally all seemed well. Then, a year on, an ugly red rash appeared on my lower back. It wasn't painful, and was hidden by my clothes at first. Then it spread right across my back, and started spreading down my arms. Although my viral load remained the same, my doctor said the therapy was failing, and that he would change my combination. I found the need to change therapy stressful. There weren't as many different types of drugs and combinations then as there are now, and I felt my options were limited. But as soon as I started the second combination, the red blotches disappeared very quickly. My viral load remained undetectable and CD4 stayed good, and both have been that way ever since." (Daniel, 38)

Salvage therapy
Salvage therapy is the term used to describe treatment for HIV when two or more previous combinations have stopped working effectively. In this situation it’s probable that you would be resistant to quite a few of the different anti-HIV drugs currently available causing these previous combinations to become less effective.

‘Salvage therapy’ can sound more last chance that it often is. Despite multiple drug resistance it is still possible in a lot of cases to find combinations of anti-HIV drugs that will be effective enough to keep your HIV from damaging your immune system to a dangerous level.

In salvage therapy, your doctor may look at putting you onto a combination consisting of four, five or even more different anti-HIV drugs. This combination could consist of a mixture of drugs that your HIV is not resistant to and drugs that your HIV has some resistance to. There is also the fusion inhibitor called T20 (or Fuzeon). This is a drug that is only usually given to people with multiple drug resistant HIV that cannot be completely managed with other anti-HIV drugs. T20 has to be taken by injection under the skin twice a day which is not ideal. If it is recommended that you start on T20, make sure you talk through all your concerns with your doctor, especially if you are uncomfortable with needles.

If salvage therapy does not manage to keep your CD4 count above 200, your doctor would probably give you some drugs to prevent you from developing certain AIDS defining illnesses. These preventative drugs are known as prophylaxis. You’ll need to talk through with your doctor how and when to take them and the possible side effects from these drugs.

The good news is that newer drugs are always being developed. Some of these drugs are in the same classes of anti-HIV drugs as the ones currently available, but are effective against multiple drug resistant HIV. Other drugs being developed are from completely new classes of anti-HIV drugs. As such these drugs should also be effective in people who currently have multiple drug resistance to anti-HIV drugs in the current classes.