Abstract
Highly-active antiretroviral therapy (HAART) has been one of the major advances in medicine in the 20th century. Millions of lives have been saved all over the world since triple drug combinations were adopted as the standard of care for HIV disease. First-line regimens may fail, generate side effects, and long term toxicities. In the past, HAART regimens were also complex and difficult to adhere to. So, second line regimens were necessary to preserve the main goal of ARV therapy: suppression viral replication and restoration of the immune system in order to keep patients alive and healthy. From a public health perspective, the impact of HIV treatment as prevention highlights the importance of having safe and effective second line options for patients unable to maintain full viral suppression with first line therapy. New strategies with effective, tolerable drugs are essential components of these regimens. The gap between wealthy and developing countries is particularly evident in the second line scenario.
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