first-line HIV treatment

'I saw it as a second chance': A qualitative exploration of experiences of treatment failure and regimen change among people living with HIV on second- and third-line antiretroviral therapy in Kenya, Malawi and Mozambique

Increasing numbers of people living with HIV (PLHIV) in sub-Saharan Africa are experiencing failure of first-line antiretroviral therapy and transitioning onto second-line regimens. However, there is a dearth of research on their treatment experiences. We conducted in-depth interviews with 43 PLHIV on second- or third-line antiretroviral therapy and 15 HIV health workers in Kenya, Malawi and Mozambique to explore patients' and health workers' perspectives on these transitions.
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Updated recommendations on first-line and second-line antiretroviral regimens and post-exposure prophylaxis and recommendations on early infant diagnosis of HIV: interim guidance

Author
World Health Organization
Since 2016, WHO has recommended tenofovir disoproxil fumarate (TDF) + lamivudine (3TC) (or emtricitabine, FTC) + efavirenz (EFV) 600 mg as the preferred first- line antiretroviral therapy (ART) regimen for adults and adolescents. WHO recommended dolutegravir (DTG) as an alternative option to EFV for first-line ART because of the uncertainty regarding the safety and efficacy of DTG during pregnancy and among people living with HIV receiving rifampicin-based tuberculosis (TB) treatment. New WHO interim guidelines contain recommendations regarding preferred first-line regimens for adults, adolescents and children initiating ART, which now include DTG and RAL.
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Global epidemiology of drug resistance after failure of WHO recommended first-line regimens for adult HIV-1 infection: a multicentre retrospective cohort study

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Yes
Author
The TenoRes Study Group

Background

Antiretroviral therapy (ART) is crucial for controlling HIV-1 infection through wide-scale treatment as prevention and pre-exposure prophylaxis (PrEP). Potent tenofovir disoproxil fumarate-containing regimens are increasingly used to treat and prevent HIV, although few data exist for frequency and risk factors of acquired drug resistance in regions hardest hit by the HIV pandemic. We aimed to do a global assessment of drug resistance after virological failure with first-line tenofovir-containing ART.

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Adherence support improves ART outcomes in Kenya

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Yes
Author
Michael Carter

The scale-up of antiretroviral therapy (ART) in Kenya is being undermined by high rates of treatment failure, investigators report in the online edition of the Journal of Acquired Immune Deficiency Syndromes. Over a third of patients failed first- and second-line therapy. Use of inappropriate regimens and lack of adherence support were associated with failure to control viral load.

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Efavirenz use not linked to neurocognitive impairment

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Yes
Author
Liz Highleyman

People who use antiretroviral regimens containing efavirenz (Sustiva or Stocrin, also in the Atriplacoformulation) were not at higher risk for impaired neurocognitive function, either overall or when looking at specific functional domains, researchers reported on Thursday at the 20th International AIDS Conference in Melbourne.

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