After first-line ART: towards an evidence-based SECOND-LINE

摘要

Access to antiretroviral therapy in low-income and middle-income countries has been scaled-up effectively in the past decade; however, failure of the first-line regimen is increasing.1 In The Lancet, the SECOND-LINE Study Group2 provide a high-quality evidence-based strategy for safe and effective treatment of patients in whom first-line treatment has failed.3 They did a randomised clinical trial to compare a WHO-recommended second-line treatment regimen—a ritonavir-boosted protease inhibitor (lopinavir) plus two or three nucleoside or nucleotide reverse transcriptase inhibitors (NtRTIs)— with a novel dual-treatment approach that combined ritonavir-boosted lopinavir with the integrase inhibitor raltegravir. The investigators showed that the efficacy of the new regimen was ncfn-inferiorto standard treatment: 223 (83%) of 270 patients in the raltegravir group versus 219 (8l%) of 271 in the control group had a plasma viral load of less than 200 copies per mL at week 48 (difference 1.8%, 95% Cl -4.7 to 8.3). No major safety issues emerged in either group. Patients who took raltegravir had significantly larger increases in CD4T-cell count than patients who took the control regimen.