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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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Changing or Stopping ART

06-25-2008
Goals in Changing Regimens

  • Restore patients clinical, immunologic and virologic response when treatment failure occurs
  • Manage serious toxicities and intolerance
  • Reduce likelihood of adverse events when certain medical conditions occur (e.g., pregnancy, TB)
Indications for Changing Treatment

  • Intolerance or unresolved and prolonged side effects
  • Treatment failure: clinical, immunologic, or virologic as outlined above
  • Toxicity such as anaemia, peripheral neuropathy, liver or renal abnormalities
  • Poor adherence: change indicated only to simplify dosing schedule to improve adherence
  • Active TB: (refer to TB/HIV co-infection)
  • Pregnancy: if regimen contains EFV
  • New therapies: may consider change in regimen as new agents with better efficacy and/or lower toxicity become available
Before Changing Therapy for  Treatment Failure , Rule Out

  • Immune reconstitution inflammatory syndrome (IRIS)
  • Untreated inter-current OIs
  • Poor adherence: must be corrected and therapy changed only after adherence issues have been addressed (unless change will improve adherence)
  • Inadequate dosing
  • Drug interactions resulting in reduced ART blood levels (e.g. NVP + rifampicin)
  • Poor absorption of drugs due to adverse effects (e.g., nausea/vomiting)
  • Inter-current infections causing transient decrease in CD4 count (if possible, repeat CD4 to confirm immunologic failure)
Changing ART Due to Toxicity

  • ABC
  • Hypersensitivity reaction: change to TDF1 or AZT
  • AZT
  • Severe anemia2, neutropenia3, or GI intolerance: change to TDF1 or ABC
  • Lipoatrophy or lactic acidosis: change to TDF1
  • d4T
  • Lactic acidosis, lipoatrophy, or metabolic syndrome: change to TDF1
  • Peripheral neuropathy: change to AZT or TDF1
  • EFV
  • Persistent and severe CNS toxicity4: change to NVP
  • Potential teratogenicity: change to NVP
  • NVP
  • Hepatitis: change to EFV
  • Hypersensitivity reaction: change to EFV with caution
  • Severe or life-threatening rash5: consult HIV specialist
Footnotes

  1. If creatinine clearance normal
  2. Exclude malaria in endemic areas; severe anemia (grade 4) defined as Hb <6.5 g/dl
  3. Neutrophil count <500/mm3 (grade 4)
  4. e.g. persistent hallucinations or psychosis
  5. Extensive rash with desquamation, angioedema, or reaction resembling serum sickness; or rash with constitutional findings (e.g. fever, oral lesions, blistering, facial oedema or conjunctivitis); Stevens-Johnson syndrome can be life-threatening. For life-threatening rash, substitution with EFV not recommended, although has been reported in small number of patients in Thailand without recurrence of rash.


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Diagnosis
 


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Zambia HIV National Guidelines

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