Consensus-based expert recommendations on the management of heavily treatment-experienced people living with HIV in the Middle East

Background: Heavily treatment-experienced (HTE) people with HIV face significant clinical challenges due to multidrug resistance, prior treatment failures, and limited effective antiretroviral therapy (ART) options. In the Middle East, these challenges are compounded by insufficient surveillance systems, limited regional guidance, and stigma-related barriers to care. The objective of this study was to develop consensus-based, evidence-informed statements for the management of HTE people with HIV in the Middle East through expert collaboration and a literature review. Methods: An expert panel of infectious disease specialists from across the Middle East conducted a literature review and applied the Delphi methodology to reach consensus on key recommendations. Statements were developed, refined, and voted on anonymously, with consensus defined as ≥ 80 % agreement. Results: A consensus was reached on eight core statements, including: defining HTE, enhanced monitoring protocols, timely adherence and resistance assessments, individualized ART construction, multidisciplinary care integration, non-pharmacological support strategies, establishment of HIV registries, and development of formal HTE HIV management guidelines with ongoing clinician training. Conclusions: These consensus statements provide a foundational framework to improve the management of HTE HIV in the Middle East. Implementation of these regionally tailored strategies may enhance clinical outcomes, address key unmet needs, and strengthen HIV care infrastructure across the region.