Introduction: India has the second largest number of HIV infections in the world. Since the introduction of generic antiretrovirals (ARVs) in 2000, there has been a steep increase in the number of individuals initiating antiretroviral therapy (ART) primarily due to the reduction in cost of ART. Highly active antiretroviral therapy (HAART) has dramatically improved survival and quality of life in people living with HIV and AIDS. Objective: Study of WHO stage, CD4 count and viral load after starting 2nd line ART. Materials And Methods: Patients were given prophylactic treatment for OI based on NACO guidelines. Patients were closely observed and followed up for clinical failure, immunological failure and virological failure. Results : Mean viral load in treatment failure was 231331 copies/ml and after 2nd line ART it was 697.63 copies/ml (P<0.05). 37% patients were in WHO stage I and 25% patients in stage IV who are on 1st line ART. After 2nd line ART 58% patients were in WHO stage I and 6% patients in WHO stage IV. 43 patients on 1st line ART were in between 40–49 kg. 42 patients on 2nd line ART were in between 40–49 kg weight. Mean weight of treatment failure patients was 47.17 kg while mean weight after 2nd line ART was 47.8 kg (P>0.05). Weight improvement required longer time monitoring than immunological and virological monitoring. Conclusion : Patients, who are not responding to 1st line ART, must switch over to 2nd line ART as early as possible after ruling out adherence issue and significant drug interaction and co morbid conditions.