Third-line Antiretroviral Therapy in a Nigerian Clinic: Case Series

Abstract

There is limited experience with use of third line regimen in sub-Saharan Africa. It is expected that about 10% of those on 1 st line treatment will fail and to be switched to 2 nd line. Another 10% of those on 2 nd line are also expected to fail and be switched to 3 rd line. Recommendation for 3 rd line in the guidelines is to include new drugs with minimal risk of cross resistance to previously used regimens such as Integrase Inhibitors and second-generation NNRTIs and PIs. We present three cases on third-line regimen on boosted Darunavir, Etravirine and Raltegravir. 66.7% viral suppression was achieved after four years of access to the medication. The third line regimen was well tolerated by the three cases and there was no report of serious adverse drug reaction. Adherence was also good in all cases. Third line regimen is effective but there is need to secure access. The cases reported had to interrupt treatment because access to free third-line ART was terminated by implementing partners. The Nigerian government is encouraged to take up the responsibility to provide third line regimen.