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Personalizing HIV Treatment
Personalizing HIV Treatment Beyond Viral Suppression

Released: November 20, 2025

Brian R. Wood
Brian R. Wood, MD
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Key Takeaways
  • People living with HIV who have sustained viral suppression may benefit from switching antiretroviral therapy regimens.
  • Personalized antiretroviral therapy regimens can improve well-being and increase safety.

Even with sustained viral suppression, people living with HIV may benefit from switching antiretroviral therapy (ART), especially if doing so can minimize side effects, reduce pill burden, avoid drug–drug interactions, or match  therapy to a person’s lifestyle and priorities. We should regularly evaluate whether each patient is taking the most suitable regimen based on their individual comorbidities, preferences, and goals.

Overcoming Barriers to Treatment Optimization
Three major barriers often prevent treatment optimization: therapeutic inertia or reluctance to change, misconceptions about who is eligible for switching, and fear of losing viral suppression. But we need not fear if each change is made thoughtfully, with review of regimen efficacy, drug tolerability and potential contraindications, and past treatment history, including results of resistance testing, whenever accessible.

We can rely on evidence-based guidance for specific ART switches, such as simplification to 2-drug combinations, and ensure that a clear follow-up plan is in place with open communication for any emerging issues and a contingency plan if challenges arise. Novel methods of assessing for contraindications, such as a genotype of proviral DNA, can be considered on a case-by-case basis, acknowledging that these methods are not perfect and should be reserved for unique circumstances in which they would affect patient management and decision-making.

It’s worth it. Regimen changes can improve treatment adherence and satisfaction, as well as overall health, which are key measures of success that extend beyond maintaining an undetectable viral load.

“Good Enough” Shouldn’t Be the Goal
I encourage healthcare professionals to move beyond a “let’s not rock the boat” mindset. Reassessing regimen appropriateness, proactively asking about side effects, and discussing convenience and satisfaction are critical to patient-centered HIV care. Even in the absence of complete historical resistance data, most individuals can safely switch using high resistance barrier regimens and careful monitoring.

We shouldn’t assume that the people we care for are satisfied with their ART regimen just because they have viral suppression. Some individuals prefer a simple oral regimen that they can take on their own, while others value the discretion and freedom of long-acting injectable therapy. The healthcare professional’s role is to help each patient identify the option that best supports their well-being.

For some, transitioning to long-acting therapy can reduce stigma and enhance mental and physical health, even when viral suppression is already achieved, even though this option does carry unique considerations and more frequent visits to the clinic.

The one thing that is certain is that the therapeutic landscape will continue to evolve, with more 2-drug oral options on the near horizon and hopefully more long-acting, nondaily therapeutic choices.

Looking Beyond Viral Suppression
Ultimately, virologic suppression remains the foundation of ART, but optimal HIV care takes it a step further. Many individuals taking older regimens could benefit from safer, simpler, more personalized options, and even individuals taking modern ART may benefit from routine reevaluations of their treatment. Regularly assessing patient priorities and satisfaction with their current regimen can bolster trust and strengthen the therapeutic relationship.

By overcoming inertia and misconceptions, healthcare professionals and multidisciplinary teams can help improve long-term outcomes and quality of life for people living with HIV. Successful HIV care means keeping the virus suppressed and also working to help each person find the regimen that best supports their overall health and aligns with their personal goals.

Your Thoughts
How do you reevaluate ART for people living with HIV in your practice? Leave a comment to join the discussion!

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