Assessment of Second-Line Antiretroviral Regimens for HIV Therapy in Africa

• Published in: The New England journal of medicine Vol. 371; no. 3; pp. 234 - 247
• Main Authors: Paton, Nicholas I, Kityo, Cissy, Hoppe, Anne, Reid, Andrew, Kambugu, Andrew, Lugemwa, Abbas, van Oosterhout, Joep J, Kiconco, Mary, Siika, Abraham, Mwebaze, Raymond, Abwola, Mary, Abongomera, George, Mweemba, Aggrey, Alima, Hillary, Atwongyeire, Dickens, Nyirenda, Rose, Boles, Justine, Thompson, Jennifer, Tumukunde, Dinah, Chidziva, Ennie, Mambule, Ivan, Arribas, Jose R, Easterbrook, Philippa J, Hakim, James, Walker, A. Sarah, Mugyenyi, Peter
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 17.07.2014
• Subjects: Adolescent; Adolescents; Adult; Africa South of the Sahara; Aged; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiretroviral drugs; Antiviral agents; Biological and medical sciences; CD4 antigen; CD4 Lymphocyte Count; Child; Clinical trials; Developing countries; Disease control; Drug dosages; Drug resistance; Drug Resistance, Viral - genetics; Drug therapy; Drug Therapy, Combination; Female; General aspects; HIV; HIV - immunology; HIV Infections - drug therapy; HIV Protease Inhibitors - adverse effects; HIV Protease Inhibitors - therapeutic use; Human immunodeficiency virus; Human viral diseases; Humans; Induction therapy; Infectious diseases; LDCs; Lopinavir; Male; Medical sciences; Middle Aged; Patients; Pharmacology. Drug treatments; Proteinase inhibitors; Pyrrolidinones - therapeutic use; Raltegravir Potassium; Reverse Transcriptase Inhibitors - adverse effects; Reverse Transcriptase Inhibitors - therapeutic use; Ritonavir; Toxicity; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral Load - drug effects; Young Adult; Africa; Africa South of the Sahara; Immunopathology; Antiretroviral agent; Retroviridae; AIDS; Immune deficiency; Lentivirus; Infection; Virus; Medicine; Chemotherapy; Treatment; Viral disease; Antiviral; Human immunodeficiency virus
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa1311274

Appropriate second-line antiretroviral therapy for HIV infection is needed in resource-limited settings. In a comparison of three protease-inhibitor–based regimens in sub-Saharan Africa, the one that included nucleoside reverse-transcriptase inhibitors performed favorably. The public health approach of the World Health Organization (WHO), 1 together with large-scale donor funding, has enabled millions of adults and children in sub-Saharan Africa who are infected with the human immunodeficiency virus (HIV) to have access to lifesaving antiretroviral therapy. 2 The key principle is the use of simplified, standardized approaches that are feasible on a large scale in resource-limited settings, 1 , 3 including a first-line regimen of two nucleoside reverse-transcriptase inhibitors (NRTIs) plus one non-NRTI (NNRTI). In most settings, treatment is monitored clinically and with the use of CD4+ counts, with typically late detection of treatment failure, accompanied by substantial . . .