Second and Third-Line Antiretroviral Regimens

As South Africa continues its rapid expansion of access to first-line antiretroviral therapy (ART), more patients will need to be switched to second-line therapy as these first-line regimens fail. However, with little experience with second-line treatments in resource-limited settings, it is not clear how well patients will do on these medications if their first regimen fails. As the cost of second-line medications is much higher than first-line, it is critical to evaluate whether these medications can be delivered effectively as part of a large-scale public health response to HIV. To date there have been only a limited number of such evaluations, as they require large databases to conduct a robust evaluation. HE²RO has developed a body of work evaluating the need for second-line ART as well as rates of failure on second-line and the need for third-treatment.