Decera Clinical Education Infectious Disease Podcast

Overcoming Reluctance to Change as a Barrier to Optimizing ART for People Living With HIV and Viral Suppression

·24 min·2 clips

Dr. Luis Buzon questions why doctors hesitate to switch HIV treatments even when patients are virologically suppressed.

The episode begins with host Zachary Schwartz introducing Dr. Monica Gandhi from San Francisco and Dr. Luis Buzon from Spain to discuss barriers to optimizing HIV treatment. Dr. Buzon opens by questioning why doctors often hesitate to switch treatments when patients are virologically suppressed, suggesting this conservative approach may not be optimal. Dr. Gandhi adds that with many therapy options now available, switching should be considered to address low-grade adverse effects or other factors beyond viral suppression. They discuss the historical context where limited options forced patients to tolerate toxicities, contrasting it with current advancements. Dr. Buzon raises the idea of over-treating with three-drug regimens, proposing that two-drug therapies based on second-generation integrase inhibitors could be sufficient for many patients, citing evidence from trials like those involving dolutegravir and lamivudine. Dr. Gandhi elaborates on the benefits of two-drug regimens, such as reducing long-term toxicities from NRTIs like tenofovir, and mentions weight gain issues associated with certain combinations. The conversation shifts to long-acting injectables, with Dr. Gandhi noting that U.S. guidelines changed in 2024 to allow their use in viremic patients with adherence challenges, based on observational data from clinics like Ward 86. Dr. Buzon discusses the reluctance among providers to adopt injectables, attributing it to fear of virologic failure, but argues that failures can be managed by switching back to oral regimens. They emphasize the importance of patient communication to uncover stigma, with Dr. Gandhi sharing an example of a patient who experienced nausea linked to HIV reminder. Dr. Buzon highlights a Spanish cohort study where over half of patients over 60 demanded to remove their HIV pill, showing stigma is widespread. The episode concludes with both doctors stressing the need for regular re-evaluation and shared decision-making in HIV care.

As heard by us

A careful HIV treatment discussion connects successful suppression with the everyday burdens that still shape care.

A stable, suppressed HIV regimen is framed as a continuing care question, not a closed case. Dr. Luis Buzon begins with the sensible pull to leave a working treatment in place, then weighs why a switch may still be worth discussing, from two-drug regimens to long-acting…

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Want to know why a suppressed HIV regimen might still deserve a second look?

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