This is not the most recent version of the article. View current version (16 JUN 2010)
Intervention Review
Antiretroviral regimens for patients with HIV who fail first-line antiretroviral therapy
Editorial Group: Cochrane HIV/AIDS Group
Published Online: 21 JAN 2009
Assessed as up-to-date: 20 AUG 2007
DOI: 10.1002/14651858.CD006517.pub2
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Database Title
Additional Information
How to Cite
Humphreys E, Hernandez LB, Rutherford G. Antiretroviral regimens for patients with HIV who fail first-line antiretroviral therapy. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006517. DOI: 10.1002/14651858.CD006517.pub2.
Publication History
- Publication Status: Edited (no change to conclusions)
- Published Online: 21 JAN 2009
This is not the most recent version of the article.View current version (16 Jun 2010)
Abstract
Background
Highly active antiretroviral therapy has reduced the morbidity and mortality of patients with HIV/AIDS. A common first-line ART regimen includes a non-nucleoside reverse transcriptase inhibitor (NNRTI) and two nucleoside reverse transcriptase inhibitors (NRTIs). If treatment failure occurs, a change to second-line therapy is necessary.
Objectives
This meta-analysis aimed to assess the optimum antiretroviral regimen for patients with HIV who fail first-line therapy (ART-naive) with d4T+3TC+NVP; d4T+3TC+EFV; ZDV+3TC+NVP; and ZDV+3TC+EFV.
Search strategy
Electronic databases and conference proceedings were searched with relevant search terms without limits to language.
Selection criteria
Randomised controlled trials of HIV-infected adult patients administered second-line ART after virologic failure of a first-line regimen were included. The primary outcome measure included the proportion of patients achieving undetectable plasma HIV RNA concentration (viral load). Secondary outcome measures included change in mean CD4 cell count, clinical resolution of symptoms, rate of adverse events, rate of change in therapy for failure, rate of change in therapy for toxicity, and mortality.
Data collection and analysis
Two authors assessed each reference for inclusion and exclusion criteria established a priori. Data were abstracted independently using a standardised abstraction form.
Main results
Twenty-one records were identified in total, 6 of which were duplicates. None of the records met inclusion criteria.
Authors' conclusions
There is insufficient evidence to evaluate second-line therapies in patients with HIV who fail first-line treatment with d4T+3TC+NVP; d4T+3TC+EFV; ZDV+3TC+NVP; and ZDV+3TC+EFV. Current recommendations are based on available resources and results from individualised treatment decisions based on resistance testing and clinician choice.
Plain language summary
Antiretroviral regimens for patients with HIV who fail first-line antiretroviral therapy
Highly active antiretroviral therapy has markedly reduced the morbidity and mortality of HIV-infected persons worldwide. There are many options for first-line ART, but second-line therapy is necessary for persons for fail the first-line treatment. This review attempted to assess the best ART regimen for HIV-infected persons who need second-line therapy; however, the reviews found no randomised controlled trials addressing this topic. While such trials are difficult to conduct for a variety of reasons, randomised controlled trails for treatment of second-line therapies are needed, especially in settings in which genotyping and close monitoring of HIV viral load is unavailable.