Most people living with HIV take a combination of medicines called antiretroviral therapy (ART). This first combination, known as first-line ART, usually keeps the virus under control for many years. But sometimes, it stops working as well as it should. When this happens, your doctor may recommend switching to a second-line treatment.
Switching does not mean your treatment has failed completely — it means your doctor is choosing stronger or different medicines to keep the virus under control. Second-line treatment works very well when taken correctly, and most people see their health improve again within months.
If you have noticed frequent illness, weight loss, or your viral load results are still high after treatment, you can speak to a doctor through Hope Plus to get personalised advice and discuss whether a treatment change might be right for you.
Why Treatment Sometimes Stops Working
Your first set of HIV medicines can stop working for several reasons:
- Missing doses often (poor adherence): When ART is not taken daily, the virus can start multiplying again and become resistant.
- Low drug levels in the blood: Sometimes other medicines, poor absorption, or irregular dosing can lower ART levels.
- Drug resistance: Some people have HIV strains that are already resistant before starting treatment.
Before switching to a new regimen, your healthcare team will talk to you about how you take your medicines and may offer extra counselling or support to help you stay on track.
How Doctors Know Treatment Is Failing
Doctors look for two main types of “treatment failure.”
1. Virological Failure (The Most Accurate Test)
This is when your viral load test shows the virus is still multiplying, even after getting adherence support.
- Confirmed if you have two viral load results above 1000 copies/ml, taken 3–6 months apart.
- You must have been on ART for at least six months before this can be confirmed.
2. Clinical Failure (Based on Illness)
This is when you develop new or recurring HIV-related illnesses even after taking treatment for six months.
- Adults and adolescents: New or returning severe infections or health problems (WHO Stage 3 or 4 illnesses, except TB).
- Children: New or recurring serious illnesses that meet WHO Stage 3 or 4 criteria (except TB).
Important: Sometimes these illnesses are due to Immune Reconstitution Inflammatory Syndrome (IRIS), which happens when your immune system starts fighting infections after beginning ART. Your doctor will rule this out before switching you to a new treatment.
What Happens When You Switch
If your doctor decides you need second-line treatment:
- You will be started on a new combination of medicines that still work against HIV.
- You will get extra support and counselling to make sure you take your medicines daily.
- Your viral load will be checked regularly to confirm that the new treatment is effective.
The goal is to bring your viral load back down to an undetectable level so you can live a healthy, normal life.
