switch to the 2 line

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Thanks for your post.

While resources differ from location to location, I don't think that the threshold to switch treatments after failure of first line therapy should. Namely, if there is a confirmed and elevated viral load that has no other explanation (ie, non-adherence, concomitant illness), then one should consider switching to an alternative 2nd line regimen.

Earlier, rather than postponed switching should help reserve the activity of the second-line NRTIs that will be used with protease inhibitor components in 2nd line. In such cases, I would definitely advocate for the use of a ritonavir( Norvir)-boosted PI, since their activity and effectiveness is far greater than unboosted PIs-- a point quite relevant if NRTI activity is potentially compromised.

Ultimately, we all should continue to strive to get optimal access to medications and diagnostics for all persons with HIV, irrespective of setting.

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