TABLE 14.

Recommended second-line regimen in patients who have failed a first-line regimen of two nucleoside reverse transcriptase inhibitors + non-nucleoside reverse transcriptase inhibitor.

Failing first-line regimen	Advised second-line regimen
TDF + 3TC (or FTC) + NNRTI	AZT + 3TC + DTG‡
AZT + 3TC + NNRTI	Resistance test: if fully active NRTI is available, then combine this with: 3TC (or FTC) + DTG, or TDF + FTC + DRV/r†
ABC + 3TC + NNRTI	AZT + 3TC + DTG‡

NNRTI, non-nucleoside reverse transcriptase inhibitor; NRTI, nucleoside reverse transcriptase inhibitor; TDF, tenofovir disoproxil fumarate; 3TC, lamivudine; AZT, zidovudine; ABC, abacavir; DTG, dolutegravir; FTC, emtricitabine; DRV, darunavir.

^†, If the patient has chronic hepatitis B, then continue TDF, in addition, in the second-line regimen.

^‡, Provided that the patient has not potentially previously experienced virological failure on TDF, and has not experienced TDF nephrotoxicity previously.