What to do Next? Second-line Antiretroviral Therapy

Abstract

Opinion statementHighly-active antiretroviral therapy (HAART) has been one of the major advances in medicine in the 20 th century. Millions of lives have been saved all over the world since triple drug combinations were adopted as the standard of care for HIV disease. Firstline regimens may fail, generate side effects, and long term toxicities. In the past, HAART regimens were also complex and difficult to adhere to. So, second line regimens were necessary to preserve the main goal of ARV therapy: suppression viral replication and restoration of the immune system in order to keep patients alive and healthy. From a public health perspective, the impact of HIV treatment as prevention highlights the importance of having safe and effective second line options for patients unable to maintain full viral suppression with first line therapy. New strategies with effective, tolerable drugs are essential components of these regimens. The gap between wealthy and developing countries is particularly evident in the second line scenario.

Growing challenges for HIV programmes in Asia: clinic population trends, 2003–2013

“…Similarly, we found a 24% increase in the proportion of patients receiving second or third ART from 2003 to 2013. Clearly, in future years, healthcare systems will need to accommodate for, not only an increased number of patients receiving ART, but also provide access to regimens beyond first-line (Figueroa, Sued, & Cahn, 2014; World Health Organisation, 2007). …”