HAART failure definition

Washington maunual, 35/e, chap. 16

HAART failure definition:

1. less than a log (10-fold) reduction of the viral load 4-6 weeks after starting a new ART
2. failure to reach an undetectable viral load after 6 months of Tx
3. detection of the virus after initial complete suppression of viral load => possible resistant
4. persistent decline of CD4 cell count or clinical deterioration

4-6 weeks after initiation of ART => viral load and CD4 count

Q3-6M regular follow under stable medication control

PI and cobicistat both inhibit andinduce the P450 system => macrolides, antifungals, rifamycins, anticonvulsants; antihistamines, antiarrhthmic (flecainide, encainide, quinidine), fentanyl, meperidine, midazolam, warfarin, statin (pravastatin is the safest), oral contraceptives