Antiretroviral regimens for patients with HIV who fail first-line antiretroviral therapy

Highly active antiretroviral therapy (HAART) has greatly reduced the illness and deaths of HIV-infected people worldwide. There are many options for first-line antiretroviral therapy (ART), but second-line therapy is necessary for people who fail the first-line treatment. This review attempted to assess the best ART regimen for HIV-infected people in low- and middle-income countries following treatment failure; however, the review found limited studies addressing this topic. One randomised trial and one abstract of an observational study evaluated whether or not to maintain lamivudine in second-line regimens; both suggested no difference in outcomes. There were no studies comparing boosted PI-containing second-line regimens in patients failing an NNRTI-based first-line regimen, nor any evaluating NRTI combinations after first-line with non-thymidine analog combinations. While such trials are difficult to conduct for a variety of reasons, randomised controlled trails comparing second-line therapies are needed, especially in resource-limited settings.