First-line regimen failure of antiretroviral therapy: a clinical and evidence-based approach
Bibliographic record
Abstract
PURPOSE OF REVIEW: To provide a clinical approach for choosing an appropriate second-line antiretroviral (ARV) regimen in HIV-positive patients with virologic failure. RECENT FINDINGS: Patients should be carefully evaluated as to why failure occurred and undergo HIV resistance testing to guide second-line treatment options. The new regimen should be initiated as soon as possible to avoid evolution of resistance. There is a paucity of clinical trial data to make recommendations for optimal second-line regimens. With failure, a member of the alternative class nonnucleoside reverse transcriptase inhibitor or ritonavir protease inhibitor] is traditionally combined with two active nucleoside reverse transcriptase inhibitors. Etravirine may be effective, if adequately supported, depending upon the resistance profile. If protease inhibitor resistance is detected, second-generation agents such as darunavir/r or tipranavir/r are preferred. Integrase or entry inhibitors may be added if there is protease inhibitor intolerance or if an active NRTI backbone cannot be constructed CONCLUSION: Many options are available for second-line regimens. Decisions should be tailored to patients' needs and results of resistance testing. Two to three active agents must be included. Although the absolute number of agents is not critical, the goal is to develop a regimen that maximally suppresses HIV viral replication and provides an adequate barrier to prevent the emergence of resistance.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".