Efficacy of Second-Line HIV Therapy in Developing Countries

Expanded use of antiretroviral therapy in resource-poor countries has brought the need for second-line regimens for patients with first-line therapy failure. Given that third-line therapy remains very expensive, understanding what might contribute to failure of second-line therapy is important. Toward this end, investigators analyzed data on 632 patients aged ≥14 who had been receiving second-line therapy for ≥6 months at any of 27 programs in Africa and Asia between 2001 and 2008.

The rate of treatment failure was 215 per 1000 person-years at 30 months of second-line therapy use (95% confidence interval, 179–257) and was highest during the first 6 to 11 months. Deaths occurred at a steady pace over time; the mortality rate at 30 months was …