The second-line regimen tenofovir/emtricitabine + lopinavir/ritonavir (TDF/FTC LPV/r) saved costs and had similar health benefits to abacavir + didanosine + lopinavir/ritonavir (ABC ddI LPV/r) and tenofovir/emtricitabine + darunavir/ritonavir (TDF/FTC DRV/r) in HIV-positive patients with first-line ART failure in Burkina Faso, Cameroon and Senegal.

Cost savings were driven by the lower monthly prices of the two nucleoside reverse transcriptase inhibitor (NRTI) drugs (TDF/FTC vs ABC ddI) and the boosted protease inhibitor (LPV/r vs DRV/r), even when the most recent antiretroviral drug prices (reported for the year 2018) were taken into consideration.

Using TDF/FTC LPV/r as alternative boosted protease inhibitor-based second-line therapy to dolutegravir, which was added as a WHO preferred second-line option in July 2018, may be the most efficient use of resources in low- and middle-income countries.