Optimization of second-line and third-line antiretroviral therapy for people living with HIV

Overview

This report summarizes the clinical evidence, key challenges and research gaps for optimizing second-line and third-line antiretroviral therapy (ART) regimens included in current WHO treatment guidelines as well as the advances in the management of adverse drug reactions and emerging drug resistance to these ART regimens from a public health perspective. The report reviewed the latest data on the potential use of darunavir/ritonavir as a preferred protease inhibitor option in second-line and third-line ART for adults, pregnant women and children; the efficacy and safety of recycling tenofovir in second-line regimens; and the comparative safety of regimens containing tenofovir alafenamide and tenofovir disoproxil fumarate, with considerations raised regarding their different side-effect profiles and use with boosted and unboosted ART regimens. 

The primary audience for this report includes national HIV program managers, clinicians, and healthcare providers. This document will also be of interest to treatment advisory boards, international agencies and organizations that provide technical and financial support to HIV programmes.