assessing the efficacy of second-line antiretroviral treatment for hiv patients failing first-line antiretroviral therapy in iran: a cohort study

there are limited documents about hiv patients switched to second-line antiretroviral therapy (art) in resource-limited countries. we aimed to assess the efficacy of second-line art for hiv patients following first-line art failure. this was a cohort study of hiv/aids patients with first-line art treatment failure switched to second-line art between january 2004 and march 2014, who followed for at least 12 months after switching. fifty of studied patients (85%) were treated with regimens containing lopinavir/ritonavir (kaletra) and nine of them (15%) treated with other regimes. seven patients were experienced opportunistic infections in accordance with stage iii and iv who classification. in this way, 11.8% of patients had aclinicalfailure, and 37 of them (62%) had immunological responses. weight gain was evident in these patients, and there was a significant correlation between theincrease in cd4 and weight gain ( p =0.007). only 13 patients achieved hiv viral load testing that 6 of them had avirological response after 12 months on second-line art. no significant associations were found between virological or immunological response and gender, age, and lopinavir/ritonavir regimens ( p >0.05).with counselling and supporting in those failing first-line art, inessential switching to more costly second-line art can be prevented in the majority of patients. however, patients' need to second-line art drugs has increased, for which national art programmes and regular follow-up should be organized. the high cost of these drugs and limited access to viral load testing are main barriers to proper management of patients switched to second-line art regimens.