A Complex but Exciting Future: New Options for Second-Line Antiretroviral Therapy

AbstractPurpose of ReviewProtease inhibitors have been the bedrock of second and subsequent line HIV therapies for more than a decade, in both high-income and low- and middle-income countries.Recent FindingsWHO ’s recommendation for ‘blind’ sequencing from first- to second-line therapies, acknowledging that genotype testing would not be available in many resource-constrained settings, has recently been supported by large randomised studies. The availability of highly potent integrase inhibitors have transformed therapy in places where these combinations are used in first and subsequent line. The resistance barrier conferred by the newer agents in this class is formidable, and it is unclear how this will influence sequencing. WHO has recommended dolutegravir as an alternative first-line agent fo r first-line therapy in 2015.SummaryThe fact that dolutegravir is cheaper in many high-prevalence countries than alternatives, and is amendable to co-formulation, means that debate about and studies looking at how to rationally use the different classes of drugs, balancing cost and toxicity, will be a priority.
Source: Current Tropical Medicine Reports - Category: Tropical Medicine Source Type: research