Can you switch HIV treatments?

HIV (human immunodeficiency virus) is a chronic but manageable condition—while there is no cure for an HIV infection, there are medications that can suppress the viral load (the amount of virus in the body) to an undetectable level. Keeping the viral load suppressed helps prevent transmission to others, helps keep the immune system healthy, and helps prevent opportunistic infections and serious complications. Treatment enables people who have HIV to live long lives in good health.

The medications used to treat HIV are called antiretroviral therapy (ART). There are several different classes of ART drugs and multiple drugs within those classes. A person typically takes a regimen of three or more ART medications. These medications are taken every day of a person’s life.

While ART therapy is a life-long commitment, many patients find that they want or need to switch the ART medications in their regimen at some point. It is possible to change medications and to do it safely, but it must be done under the guidance of a healthcare provider.

Here, we look at the reasons people switch to different HIV medications and how to make the switch safely.

Reasons for switching HIV medications

There are numerous reasons why a person would make changes to their ART regimen. Some common reasons include:

• If a current regimen is causing side effects, a person may want to switch to a different regimen with a lower risk of side effects.
• A different regimen may mean taking fewer pills each day. This is referred to as “pill burden.” The more pills that need to be taken, the higher the pill burden.
• Some medications must be taken with food, which can be inconvenient—for example, for people who work rotating shifts.
• Some ART pills are larger than others. Smaller pills may be preferred by people who have difficulty swallowing.
• A different medication may be less expensive, or a person may have changed insurance coverage.
• If a person with HIV or their partner are pregnant or plan on becoming pregnant, certain ART medications may be preferred because there is more data about those ART medications and pregnancy.
• A patient or healthcare provider may want to update a regimen to include newer HIV medications that were not available when a person began HIV treatment.
• A different medication may have a lower risk of drug resistance. This may be the case for people who struggle with adherence. HIV infections can become resistant to certain drugs when they are not taken consistently.
• Certain HIV medications may interact with medications a person is taking for another condition.

Sometimes treatment fails to achieve the result that you and your healthcare providers are looking for. This is referred to treatment failure. In the case of treating HIV, this can mean that the regimen has not adequately suppressed the viral load or that the CD4 count (white blood cell count) is not improving. Treatment failure can occur when an infection is resistant to the medications being used. It can also occur because of nonadherence to treatment (which can contribute to drug resistance).

Making a switch

Broadly speaking, people who are changing their regimen will fall into two categories—those who have achieved virologic suppression and those who have not. When a person has achieved virologic suppression, the goal is to switch medications without the viral load increasing. When a treatment has failed and virologic suppression has not been achieved, the goal is to find a new regimen that adequately suppresses viral load and improves white blood cell count.

The most important thing to do when switching to a different HIV regimen is to work closely with your healthcare provider. Never stop taking an HIV medication unless directed to by your healthcare provider. Every person is different—and differences in medical history, treatment history, drug tolerance, personal preferences, and many other factors are important to success with HIV treatment.