Perspective What Is the Optimal First Line Antiretroviral Therapy in Resource-Limited Settings?

Choosing an optimal first line antiret-roviral therapy (ART) in resource-limited settings (RLS) involves a careful balancing act. On the one hand, we would want to ensure that patients receive the most efficacious therapy available. On the other hand, the most efficacious regimens may be too costly for countries afflicted by the dual burdens of very high HIV prevalence and of resource scarcity. This dilemma is compounded by the recent emergence of good quality evidence to start ART earlier (i.e., at higher CD4 counts), which can improve life expectancy [1], reduce the risk of tuberculosis acquisition [1], and reduce the transmission of HIV [2]. These considerations will mean that about 9 million extra people will need to be placed on ART by 2015 [3]—all in the context of a decline in global funding for AID