WHO consultation on ART failure in the context of a public health approach

26-27 February 2008
Montreux, Switzerland

Antiretroviral therapy rollout has led to an increased number of patients on ART, with more than 3 million people now being treated. Key to this progress has been the public health approach, which is based on standardized simplified protocols that can be provided to the entire affected population and that aims to avoid mortality and morbidity and improve the quality of life for the most people possible.

This creates a standard first line regimens, which is “switched” to a standard second line regimens at treatment failure. Universal access to ART includes access second line therapy, and as programmes expand, the need for second line therapy will increase. Guidance on which ARVs to use second line therapy has recently been published by the WHO, and although it is 5-10 times more expensive, it is now becoming accessible. The 2006 WHO treatment guidelines include recommendations for switching to second line therapy. However additional clarification on when to switch ART is requested.

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