Antiretroviral Therapy

Prior to starting ART, patients should be assessed for readiness to take ARVs; the ARV regimen; dosage and scheduling; the likely potential adverse effects; and the required monitoring. Both medical and psychosocial issues need to be addressed before initiating ART. Patients should be adequately counseled about adopting appropriate life style measures such as safer sexual practices (including appropriate use of condoms), and any other psychosocial problems that may interfere with adherence (e.g.

WHO defines treatment adherence as ‘the extent to which a person's behaviour- taking medications, following a diet and/or executes lifestyle changes’ corresponds with agreed recommendations from a health care provider.

Ideally, patients who fail to respond to first-line treatment should be treated with a different regimen containing medicines that were not included in the first regimen. The second-line regimen will consist of two NRTIs but with a PI if the initial regimen contained DTG. The second-line regimen should be initiated only after assessing treatment adherence and failure and in consultation with a specialist in HIV and AIDS treatment or the clinical mentorship team at the OI/ART clinic, as the recom

A. Tenofovir 300mg {TDF (or TAF)} + Lamivudine 300mg (3TC) + Dolutegravir 50mg (DTG) or ABC + 3TC + DTG

lf TDF + 3TC or ABC + 3TC (or FTC) was used in the failing first-line regimen, AZT + 3TC should be used in second-line ART and vice versa

In adolescents older than 12 years and adults; the preferred 3” line ART can include Dolutegravir (50mg), Darunavir (600mg)/Ritonavir (100mg) and 2NRTIs.

(Refer to the latest national TB guidelines or TB/HIV guidelines)

In patients who have HIV-related TB but are not yet on ART, treatment of TB takes priority. ART should be started at least two weeks after the start of TB therapy i.e. during the intensive phase when the patient has stabilised on TB treatment regardless of their CD4 count status. Cotrimoxazole prophylaxis should be provided with the commencement of the TB therapy if the patient is not on it already.

Patients initiating ART with undiagnosed cryptococcal disease are at higher risk of early mortality than patients who are pre-emptively diagnosed and treated for cryptococcal disease. All patients initiating ART should be clinically screened for evidence of symptomatic cryptococcal disease — headache, neck stiffness, fever, focal neurologic signs, confusion, and altered mental status. All those who screen positive should be referred for further diagnostic work up for meningitis. Screening of asy

More than 90% of HIV-infected children acquire their infection through mother to child transmission of HIV (vertical transmission). Thus, elimination of new HIV infections among children through effective PMTCT interventions should be prioritized. HIV disease progression occurs very rapidly in the first few months of life in infants acquiring HIV in utero, often leading to death. The importance of early infant diagnosis (EID) of HIV infection and early initiation of ART can therefore not be over

Birth PCR where available will be done within 48hrs of birth ONLY for high MTCT risk infants. ART initiation is recommended as soon as birth PCR results are available. For babies who test HIV positive at birth ALWAYS retest and confirm results with repeat PCR but retesting should not delay ART initiation. Babies who test negative at birth (birth PCR) or not tested MUST be tested at 6 weeks. Infants at high risk of transmission will receive dual ARVs (AZT and NVP) for 12 weeks as prophylaxis if b

Antibody tests (rapid and laboratory-based ELISA) are the preferred method of diagnosis for HIV infection for children over 18 months of age.

Initial care Care for HIV-exposed infants should include the following: e Make sure HIV-exposed infants are entered into the “HIV exposed follow-up register”.

Pre-exposure prophylaxis (PrEP) is the use of ARVs by people who are not infected with HIV before HIV exposure in order to prevent the acquisition of HIV. With optimum adherence, oral PrEP is more than 90% effective in reducing the risk of HIV infection.

In people who have been exposed to HIV through needle-stick inoculation or through contamination of mucous membranes by secretions, it has been shown that administration of ARVs within 72 hours of exposure reduces the likelihood of HIV infection being transmitted. There are also similar benefits of reduction of HIV transmission following use of PEP within 72 hours for those who have been sexually assaulted (rape, intimate partner violence or sexual abuse) or had a high risk unprotected sexual en