Switching to Second Line Treatment

Dear Colleague,

VisualWe invite you to join our new online course on failure of first line HIV therapy and switching second line to update your knowledge on virological failure, when and how to switch patients to second line therapy, and the future of second line treatment.



There is a major ongoing effort to provide HIV infected patients with access to antiretroviral therapy (ART), especially in resource-limited regions. However, patients are at substantial risk of failing their initial ART treatment. Treatment failure is defined as the progression of the disease after a patient has been initiated on ART, and can be assessed using clinical, immunological and virologic criteria. The true extent of treatment failure is unknown, but one study in South Africa found that 8-17% of patients failed on first-line ART after 5 years.1 Two key causes of treatment failure are lack of adherence and drug resistance. To improve patient outcomes it is crucial to identify patients who experience treatment failure and to initiate second-line therapy.
While there has been a great effort to provide ART to people living with HIV in resource-limited settings, many who experience treatment failure go unrecognized and hence are not timely switched to second-line therapy. The reasons for this may include:

  • Challenges in identifying patients who experience treatment failure due to lack of routine viral monitoring (sometimes due to poor laboratory infrastructure, no regular viral load testing and limited access to resistance testing)
  • High costs and limited availability of second-line treatment options
  • Lack of training and knowledge of healthcare professionals to switch patients to effective second-line treatment

Delayed switching to second-line therapy increases the risk of drug resistance, opportunistic infections and mortality among people living with HIV.2 Therefore, timely switching to second-line treatment is essential. This online course will inform healthcare professionals about second-line treatment options and guidelines, so that they gain knowledge and confidence for their daily practice.

Expected outcomes

After following the online masterclass, the participants will be able to
  • Define treatment failure
  • Identify risk factors for treatment failure
  • List second-line treatment options
  • Describe challenges regarding second-line treatment in the context of their own setting and discuss how they may be addressed

Target audiences

  • HIV treating Clinicians (both specialists and primary care physicians)
  • Nurses (who see/ treat HIV infected patients)
  • Other healthcare workers, researchers, healthcare policy makers, public health workers, involved in HIV care, as well as patient organizations / representatives, pharmaceutical companies