Second-Line ART Regimens for Resource-Limited Settings

A boosted protease inhibitor (PI) plus two nucleoside reverse-transcriptase inhibitors (NRTIs) is currently recommended by the WHO as second-line therapy, despite limited data on efficacy and safety. Raltegravir, an integrase inhibitor, offers the option of removing or replacing NRTIs for higher efficacy and lower toxicity. In the Europe–Africa Research Network for Evaluation of Second-Line Therapy (EARNEST) trial, which involved 1277 HIV-infected individuals from five sub-Saharan African countries, researchers assessed whether a PI plus raltegravir was superior to a ritonavir-boosted PI plus two or three NRTIs.

The raltegravir-containing regimen was not found to be superior to the NRTI-containing regimen. Good HIV disease control (i.e., no …