AIDS research and human retroviruses 2017 08 10() doi 10.1089/AID.2017.0134
The delay between first-line antiretroviral therapy (ART) failure and initiation of second-line ART – in resource-limited settings – can be prolonged. Increasing evidence links delayed antiretroviral switch with increased risk for opportunistic infection (OI) and death, particularly in patients with advanced HIV at the time of first-line failure. As access to viral load monitoring widens beyond a few countries, mechanisms are needed to optimize the use of routine virologic monitoring and assure that first-line regimen failure results in prompt second-line switch. For patients with advanced HIV or OI at the time of first-line failure, a targeted fast-track to second-line ART should be considered, involving a switch to second-line ART during a single visit. To derive the maximum benefit from both the current expansion of VL monitoring and the falling costs of second-line ART, clinics and health care workers should be given the tools and training to detect and switch patients with regimen failure prior to HIV disease progression.