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HIV Guide
 Zambia HIV National Guidelines
 


Introduction  

HIV Counseling and Testing  

Sexually Transmitted Infections (STIs)  

General Principles of Antiretroviral Therapy for Chronic HIV Infection in Adults and Adolescents  

When to Start ARV Therapy for Chronic HIV Infection in Adults and Adolescents  

Initial Regimen for ARV Therapy  

Adherence  

Baseline evaluation and Monitoring  

Calculations: Ideal Body Weight, Body Mass Index and Creatinine Clearance  

ARV Therapy for Individuals with Tuberculosis Co-Infection  

Adverse Effects and Toxicity  

Immune Reconstitution Inflammatory Syndrome (IRIS)  

Changing or Stopping ART  

Treatment Failure  

Stopping ARV Therapy  

Post Exposure Prophylaxis  

Cotrimoxazole Prophylaxis  

WHO Staging in Adults and Adolescents  

Nutrition Care and Support  

Palliative Care in HIV and AIDS  

 Guide Editors
 Editor In Chief
    Joel E. Gallant, MD, MPH

Pharmacology Editor
    Paul Pham, PharmD, BCPS

Zambia Guideline Team
   Peter Mwaba MMed PhD FRCP
   Alywn Mwinga MMed
   Isaac Zulu MMed MPH
   Velepie Mtonga MMed
   Albert Mwango MBChB
   Jabbin Mulwanda MMed FCS
 

 

 

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Baseline evaluation and Monitoring

05-06-2008
Monitoring ARV Therapy

  • Before initiation and after starting ART, patient must receive appropriate lab testing and clinical monitoring and follow-up. Purpose is to:
  • -assist in choice of initial regimen
  • -assess effectiveness of therapy
  • -evaluate potential side effects or toxicity from ART
  • -assess and re-enforce adherence to therapy
  • -evaluate for development of other HIV-related illnesses
  • Some patients may need to be seen more often than others because of side effects, difficulty with adherence, or other reasons. Providers should be flexible according to needs of individual patient.
Minimum Recommended Timing and Frequency of Follow-ups


Timeline


Baseline

Clinical

-Complete History & Physical (including ART history, current meds)
-Counseling/Education
-Risk Reduction
-Adherence
-Complaints
-Fears
-New illnesses
-Urinalysis for urine protein

Laboratory

Creatinine* (preferable for all cases but required if to start TDF)
-ALT and/or AST**
(required if to start NVP)
-Hgb, WBC
(required if to start AZT)
-CD4

-If available chemistry panel to include glucose, cholesterol, triglycerides

Other

-RPR
(repeat yearly)
-PAP smear
(if unavailable, then visualization with acetic acid screening)

-If available, HBsAg
-Pregnancy testing in women of reproductive age

Timeline 

Week 2

Clinical

-Targeted History & Physical
-Counseling/Education
-Risk Reduction
-Adherence (dose adjustments if on NVP)
-Complaints
-Fears
-Side effects
-New illness/IRIS 

Laboratory

-If on NVP and
CD4>250, or
pregnant or
rash- check ALT and/or AST

Other

Review labs from previous visit(s)

Timeline

Week 4

Clinical


-Targeted History & Physical
-Counseling/Education
-Risk Reduction
-Adherence
-Complaints
-Fears
-Side effects
-New illness/IRIS 

Laboratory

-If on NVP - ALT and/or AST
If on AZT -Hgb

Timeline

Every month for next 2 months

Clinical

-Targeted History & Physical
-Counseling/Education
-Risk Reduction
-Adherence
-Complaints
-Fears
-Side effects
-New illness/IRIS 

Laboratory

-If on NVP- ALT and/or AST

Timeline

Every 3 months

Clinical

-Targeted History & Physical
-Counseling/Education
-Risk Reduction
-Adherence
-Complaints
-Fears
-Side effects
-New illness/IRIS 

Laboratory


-If on NVP- ALT and/or AST

Timeline

Every 6 months    

Clinical

-Targeted History & Physical
-Counseling/Education
-Risk Reduction
-Adherence
-Complaints
-Side effects
-Fears
-New Illness     

Laboratory

-If on TDF- Creatinine*
-WBC, Hgb, ALT
CD4
-viral load if available

-If on PI-containing regimen, consider Chemistry profile (including LFTs, glucose, cholesterol, and triglycerides) on a yearly basis if normal; if abnormal, treat as indicated     

Other

-Repeat PAP at 6 months and if normal, every 12 months

-If visual screen only with acetic acid, repeat as with Pap smear if normal; if abnormal, refer for treatment


  • Baseline:
  • Clinical:
  • -Complete History & Physical (including ART history, current meds)
  • -Counseling/Education
  • -Risk Reduction
  • -Adherence
  • -Complaints
  • -Fears
  • -New Illnesses
  • Laboratory:
  • -Creatinine* (preferable for all cases but required if to start TDF)
  • -ALT and/or AST**(required if to start NVP)
  • -Hgb, WBC (required if to start AZT)
  • -CD4
  • -Urinalysis for urine protein
  • -If available chemistry panel to include glucose, cholesterol, triglycerides
  • -RPR (repeat yearly) 
  • Other:
  • -PAP smear (if unavailable, then visualization with acetic acid screening)
  • -If available, HBsAg
  • -Pregnancy testing in women of reproductive age
  • Week 2:
  • Clinical:
  • -Targeted history & physical
  • -Counseling/Education
  • -Risk Reduction
  • -Adherence (dose adjustments if on NVP)
  • -Complaints
  • -Fears
  • -Side effects
  • -New illness/IRIS
  • Laboratory:
  • -If on NVP and CD4 >250, or pregnant or rash, check ALT and/or AST
  • Other:
  • -Review labs from previous visit(s)
  • Week 4:
  • Clinical:
  • -Targeted history & physical
  • -Counseling/education
  • -Risk reduction
  • -Adherence
  • -Complaints
  • -Fears
  • -Side effects
  • -New illness/IRIS
  • Laboratory:
  • -If on NVP, ALT and/or AST
  • -If on AZT, Hgb
  • Every month for next 2 months:
  • Clinical:
  • -Targeted history & physical
  • -Counseling/education
  • -Risk Reduction
  • -Adherence
  • -Complaints
  • -Fears
  • -Side effects
  • -New illness/IRIS
  • Laboratory:
  • -If on NVP, ALT and/or AST
  • Every 3 months:
  • Clinical:
  • -As above
  • Laboratory:
  • -If on AZT, Hgb
  • -If on NVP, ALT and/or AST
  • -If on TDF, creatinine (calculate creatinine clearance: see Calculations)
  • -Viral load if available
  • Every 6 months:
  • Clinical:
  • -Targeted history & physical
  • -Counseling/education
  • -Risk reduction
  • -Adherence
  • -Complaints
  • -Side effects
  • -Fears
  • -New Illness
  • Laboratory:
  • -If on TDF, creatinine (calculate creatinine clearance: see Calculations)
  • -WBC, Hgb, ALT, CD4
  • -viral load if available
  • -If on PI-containing regimen, consider chemistry profile (including LFTs, glucose, cholesterol, and triglycerides) on yearly basis if normal; if abnormal, treat as indicated
  • Other:
  • -Repeat PAP at 6 months and if normal, every 12 months
  • -If visual screen only with acetic acid, repeat as with Pap smear if normal; if abnormal, refer for treatment

 
Diagnosis
 


Complications of Therapy


Malignancies


Miscellaneous


Opportunistic Infections


Organ System

Drugs
 


Antimicrobial Agents


Antiretrovirals


Miscellaneous

Guidelines
 


Zambia HIV National Guidelines

Management
 


Antiretroviral Therapy


Laboratory Testing


Miscellaneous

Pathogens
 


Bacteria


Fungi


Parasites


Viruses

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