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Complete viral suppression is the goal of pediatric HIV care, but when first-line antiretroviral therapy (ART) fails, clinicians have limited and imperfect second-line options. Tenofovir disoproxil fumarate (TDF), a common backbone drug, carries concerns about long-term kidney and bone effects. And many of the anchor drugs used in second-line treatment require ritonavir boosting, which makes them harder to administer and tolerate.
In a large multicenter trial in Africa, investigators randomized almost 1000 children aged 3 to 15 years who had failed a first-line nonnucleoside reverse-transcriptase inhibitor–based regimen to receive either a newer backbone (tenofovir alafenamide fumarate–emtricitabine [TAF-FTC]) or standard care (abacavir or z…