Hello and thank you for your post.
Following failure (and emergent resistance) to a first-line unboosted PI, I'd recommend using a ritonavir-boosted PI as part of second-line treatment. The presence of NNRTI resistance indicates that while etravirine (Intelence) will have activity, clinical trials show that the use of etravirine as the third agent in this situation is less effective that a boosted PI.
An alternative would be to include raltegravir (Isentress) in a second-line regimen; though it is important to consider that one needs a active 2nd and 3rd drug for optimal effectiveness.
Your patient is on d4T and 3TC currently, but your note does not mention the presence of NRTI resistance. Typically we'd switch NRTIs to tenofovir/FTC (Truvada), since TDF often retains activity following failure of a first-line thymidine (at least when there's no measurable resistance on genotype).
I hope this helps.
BY
