Designing a new regimen for patients with treatment failure should always be guided by ARV history and results from current and past resistance testing. This table summarizes the text above and displays the most common or likely clinical scenarios seen in patients with virologic failure. For more detailed descriptions, please refer to the text above and/or consult an expert in drug resistance to assist in the design of a new regimen. It is also crucial to provide continuous adherence support to all patients before and after regimen changes.
Preliminary data from Botswana suggested that there is an increased risk of NTDs in infants born to individuals who were receiving DTG at the time of conception.47,48 Pregnancy testing should therefore be performed for those of childbearing potential prior to initiation of DTG. If there is an alternative option, DTG should not be prescribed for those who are pregnant and within 12 weeks post-conception or those who are of childbearing potential and who are planning to become pregnant or who are not using effective contraception. When DTG is the only treatment option, or one of few treatment options, providers should counsel individuals who are pregnant or of childbearing potential about the possible association between NTDs and DTG use during conception. The decision of whether to initiate or continue DTG should be made after careful consideration of this risk and the risks of persistent viremia in the patient and HIV transmission to the fetus if pregnancy occurs while the patient is not on effective ART.