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For patients who do not achieve full HIV suppression on potent combination antiretroviral therapy, the key management question is whether to continue or stop the drugs that are incompletely suppressive. The SMART study demonstrated that stopping antiretroviral therapy completely is not a good strategy (ACC Nov 29 2006), but partial treatment interruption may be a viable approach for selected patients. For some agents (such as 3TC), clinical trial data verify that the drug has continued activity and favorable effects despite high-level resistance. For other agents, however, the situation is less clear, and a particularly vexing decision is whether to continue T-20.
T-20 is difficult to administer, is very expensive, and may lead to troublesom…