Empirical Salvage Antiretroviral Therapy Can Work

In developing countries, the management of HIV infection is considerably less laboratory-intensive than in the West. Failure of an initial antiretroviral therapy (ART) regimen may be diagnosed based on clinical illness or CD4-cell count rather than viral load, and second-line treatment may be dictated by what drugs are available rather than by genotype-guided choices. How effective is this strategy?

Researchers followed the course of 232 HIV-infected patients in Africa who experienced clinical, immunologic, or virologic failure on an initial nonnucleoside reverse transcriptase inhibitor–based regimen and then started an empirical second-line regimen based on a boosted protease inhibitor (PI). Viral-load and genotype testing at the time of th…