Lay summary
Background: in industrialized countries, the prognosis of HIV infection has improved considerably since the advent of highly active antiretroviral therapy (ART) in 1996. In lower-income countries with a high burden of HIV/AIDS, ART has become more widely available only in recent years. Most of the time however, patients are maintained in a first line regimen unless a clinical event trigger a switch to a subsequent new so-called second line regimen. With increased exposure to ART, the risk of resistance and subsequent treatment failure is rising.Aim: this study aims to analyse a combined dataset based on two large collaborations of ART treatment programmes in lower income settings, the ART-LINC collaboration and Médecins sans Frontières (MSF); we aim at determining the rates and determinants of switching to second-line regimens and at comparing clinical and biological outcomes between patients who switched and patients who did not switch to a second line regimen. Significance: This project provides a unique opportunity to study antiretroviral treatment outcomes on second-line ART in various treatment programmes in lower income settings. Because of its very large sample size (more than 100’000 patients will be included), we will be able to investigate patients and sites with different characteristics, and therefore be able to generalize our findings. The results are likely to contribute significantly to the ongoing debate on second-line ART in resource-limited settings and inform policy makers on the critical actions that should be taken to allow more patients to benefit from an efficient second-line HIV therapy.