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Second-Line HIV Treatment

Individuals who have HIV and who have never taken medication for it are considered to be "treatment naive." The first combination of medicines that a patient receives is known as her first-line treatment, with each successive combination being numbered as the next treatment line. New treatment lines are given when the current combination is considered to have failed to slow or stop the progress of infection.

  1. Failure of the First-Line Treatment

    • The first combination or drug "cocktail" that an HIV-positive individual is given will generally not be her last. There are several reasons that first-line treatment can fail, including less-than-perfect adherence to the medication schedule and adaptation of the virus to the treatment. The majority of first-line treatment combinations will fail.

    Indications of Treatment Failure

    • A treatment is considered to have failed if viral load counts go up and CD4 counts go down in three consecutive sets of blood work. Once a treatment line has failed, a new treatment combination must be administered.

    Timing of Second-Line Treatments

    • If a first-line treatment combination has failed, it is important to start a new one as soon as possible. A second-line treatment will likely have been developed before the third set of blood work has been completed so that it can be administered quickly to get the virus back under control.

    Failure of Second-Line Treatments

    • First-line treatments are not the only treatment line that can fail to control HIV. Second-line treatments can fail as well and, in fact, are twice as likely to fail as the original treatment. Despite this, they are an important part of maintaining low viral loads and high CD4 cell counts for as long as possible.

    Third-Line Treatments and Beyond

    • If a second-line treatment fails, a third-line treatment will not be far behind. Additional treatment lines with new combinations will be given should the third-line treatment eventually fail as well. New HIV medications are developed almost every year, giving doctors a nearly limitless arsenal of drugs that can be combined to help keep an HIV infection under control.

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