High Rates of Virologic Failure Among Patients on Second-Line ART in Resource-Constrained Settings

A growing number of HIV-infected patients in resource-constrained settings are now on second-line antiretroviral therapy (ART), but little is known about outcomes in such patients. To that end, researchers conducted a systematic review of 19 studies involving 2035 patients on second-line ART in Botswana, South Africa, Malawi, Uganda, Tanzania, Cambodia, Thailand, and rural China.

The cumulative pooled proportion of patients with virologic failure on second-line ART was 22% at 6 months, 27% at 24 months, and 38% at 36 months. Mortality rates after 12 months of second-line therapy ranged from 5% to 11%.

Only five studies assessed the potential role of adherence in second-line treatment failure, but they were consistent in showing that patients …