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ART Switch: When and Why
ART Switch: When and Why

Released: August 04, 2026

Cristina I. Gruta
Cristina I. Gruta, PharmD, AAHIVP
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Key Takeaways
  • Proactive discussion of ART switch with patients on suppressive regimens can identify treatment dissatisfaction, emerging or evolving comorbidities, new medication interactions, and opportunities to optimize therapy.
  • Shared decision-making is a key method to ensure patients understand their treatment options and that ART choices reflect both clinical considerations and individual preferences.

Advances in modern antiretroviral therapy (ART) for HIV have shifted the treatment paradigm away from solely prioritizing virologic suppression towards individualized care. Sometimes, this means considering an ART switch for people who are already on suppressive regimens. It is our responsibility as providers to make patients aware of possibilities for switching, particularly if a newly available regimen may suit them better, or if newly reported information suggests a different regimen would better suit their needs. [Coder link to: https://deceraclinical.com/education/program/infectious-disease/why-switch/65516]

Strategies for Proactive Switch
With the availability of medical information through multiple outlets, including social media and direct-to-consumer advertising, patients may initiate conversations about potential regimen switches. However, many times patients may not know to ask about the potential, or even the need to switch, especially when they have maintained durable viral suppression on a regimen they have taken for years.  As providers, it is good and necessary to check in regularly with our patients regarding their ART regimens.

This can be as simple as asking whether they are still happy with their current regimen, or if there is something about it that isn’t working for them. Pill fatigue, whether that means the sheer number of pills taken or how frequently they are taken, is a very common report. Hearing that might be a segue towards exploring regimen simplification, switching to single-tablet regimens or long-acting injectable ART.

When asking about satisfaction with current regimens, our patients may raise concerns about both short- and long-term adverse effects. This can range from abdominal upset to concern for developing renal or cardiovascular disease. These concerns may lead to a discussion about switching to better tolerated or less toxic options. Proactive conversations about ART satisfaction may also uncover other personal goals, including the desire for lower out-of-pocket expenses or decreasing HIV stigma by switching to an injectable ART regimen.

Clinical Reasons for Switch
Proactively discussing ART switch can not only reveal dissatisfaction with treatment but also may uncover potential clinical reasons to consider ART switch. This often involves the interplay of comorbid conditions with ART or the potential for ART agents to cause or exacerbate a condition.

First, are there scenarios where our patient’s current ART regimen must be changed because they have developed a condition for which it may not be safe to continue that same regimen. For instance, worsening renal function may drive a switch to a regimen that is not renally cleared.  Second, certain short- or long-term adverse effects of antiretrovirals may be contributing to or be a main driver in developing a new disease state. For example, there are times when ART regimens are changed to avoid or mitigate renal toxicity, cardiovascular risk, or metabolic disorders.

When patients have preexisting or develop comorbid conditions for which medications are inevitably started, this increases the potential for drug–drug interactions with their current ART. It is imperative to routinely review all medications our patients are taking so we can identify, avoid, or appropriately manage these interactions. Sometimes management of drug–drug interactions necessitates an ART switch.

Finally, there is the opportunity to modernize therapy. ART continues to evolve, with ongoing innovation aimed at developing novel virus targets, simplifying regimens, potentially reducing long-term adverse effects, and expanding administration options. In addition to standard 3-drug ART regimen options, we now have more 2-drug and long-acting injectable antiretroviral regimens, providing patients with more choices than ever before. 

Shared Decision-making
In situations where the goal of suppressed viral load has been achieved and there is nothing inherently wrong with an individual’s current ART regimen, shared decision-making is key to determining if ART switch could still improve their satisfaction with or clinically optimize their care.  Engaging in shared decision-making provides space to exchange evidence and articulate patient goals to make sure that the individual is aware of all their options, especially if a newly available regimen may better suit their lifestyle or preferences, or if new information suggests a different regimen would better suit their needs.  

Ultimately, shared decision-making ensures that the individual has a say in their care, contributing greatly to treatment satisfaction. In a recent study of more than 2000 people living with HIV, more than two thirds wanted more involvement in decisions about their HIV treatment, but only a small minority felt like their opinions were being heard. This study highlighted a significant treatment gap that shared decision-making can help address. Rather than solely prioritizing virologic suppression, I think it is crucial to make sure that individual goals and preferences are being honored in HIV care.

In all, shared decision-making conversations are a good time to check in with people about if they're interested in and ready for change. Based on their readiness and any clinical reasons that may be present, you can then make a collaborative decision about whether a switch may be beneficial.

Your Thoughts
What patient circumstances would prompt you to proactively discuss an ART switch? Leave a comment to join the discussion. You can also sign up here to view our live webinar on ART switch, featuring insights from the National Clinician Consultation Center!

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