Second-Line Therapy for People with HIV: A New Standard of Care

Until recently, a nonnucleoside reverse-transcriptase inhibitor (NNRTI) plus tenofovir/lamivudine was commonly used for initial HIV therapy in many parts of the world. For patients who developed virologic failure, the WHO recommended dolutegravir or a protease inhibitor such as darunavir, and switching tenofovir to zidovudine while continuing lamivudine. Now, in the NADIA trial conducted in sub-Saharan Africa, investigators rigorously evaluate this approach. Patients who had virologic failure on an NNRTI plus tenofovir with lamivudine (or emtricitabine) were randomized to receive dolutegravir or ritonavir-boosted darunavir in combination with either tenofovir/lamivudine or zidovudine/lamivudine.

Among 484 participants, rates of virologic sup…