In this open-label trial in sub-Saharan Africa , we randomly assigned 1277 adults and adolescents with HIV infection and first-line treatment failure to receive a ritonavir-boosted protease inhibitor ( lopinavir-ritonavir ) plus clinician-selected NRTIs ( NRTI group , 426 patients ) , a protease inhibitor plus raltegravir in a superiority comparison ( raltegravir group , 433 patients ) , or protease-inhibitor monotherapy after 12 weeks of induction therapy with raltegravir in a noninferiority comparison ( monotherapy group , 418 patients ) .