A wake-up call for global access to salvage HIV drug regimens

Abstract

For HIV-infected populations fortunate enough to access treatment combination antiretroviral therapy (cART) profoundly reduces mortality. A wide variety of antiretrovirals have been developed in the past decade but few are accessible to most patients in developing countries. In such settings only one or two regimens are normally available which results in disastrous consequences when these regimens fail. The success of first-line therapy for these populations is of pressing concern. In todays Lancet Andrew Phillips and colleagues report on a UK cohort of patients with low rates of triple-class drug failure1 especially those starting therapy with CD4 counts greater than 200 per µL. The good news is that few patients had extensive drug failure. The bad news is that of those patients with extensive drug failure most had failed more than seven drugs and a large proportion of those (58%) failed second-line therapies. This finding has implications for the treatment of patients in developing settings where access to multiple drugs within classes are limited and resistance testing and viral load evaluations are luxuries outside the realm of routine clinical care. (excerpt)