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

  • Review
  • Intervention

Authors


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.