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 Zambia HIV National Guidelines


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  


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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Adverse Effects and Toxicity


Goals of Managing Drug Adverse Effects

  • Maintain good adherence
  • Reduce potential adverse impacts of drug side effects
  • Identify serious adverse drug reactions and manage appropriately
Principles in Managing Toxicities

  • Determine seriousness of toxicity and manage according to severity
  • Establish whether adverse event due to ART or to other medication or illness (e.g., viral hepatitis, malaria, IRIS)
  • An individual drug may be substituted due to toxicity
  • Stress adherence despite mild to moderate reactions
  • If ART must be stopped because of severe life-threatening toxicity, stop all drugs together until patient stabilized
  • Adverse events should be recorded and reported regularly to HIV/AIDS program manager and to National Pharmacovigilance Unit at Pharmacy Regulatory Authority
  • Early complications seen most commonly when therapy started in pts with severe immunodeficiency. Mortality increased in 1st 6 months on treatment, especially in patients with Stage IV disease and severe immunosuppression
General Prevention and Management of Adverse Effects

  • Educate patient about possible adverse effects
  • Consider other medical conditions (e.g. hepatitis) and medications when selecting regimen to decrease risk of adverse effects
  • Follow recommendations for lab and clinical monitoring while on ART
  • Educate about symptoms of life-threatening conditions
  • Make sure patient knows how to reach provider for questions or concerns

  • GRADE 1 (mild)
  • Transient or mild discomfort, no limitation in activity no medical intervention needed
  • Does not require change in therapy, symptomatic treatment may be given
  • GRADE 2 (moderate)
  • Limitation in activity, some assistance may be needed; no or minimal medical intervention/therapy required
  • Continue ART if possible; if no improvement consider substitution with drug in same class but with different toxicity profile
  • GRADE 3 (severe)
  • Marked limitation in activity, some assistance usually required, medical intervention required, possible hospitalization
  • Substitute offending agent without stopping therapy
  • GRADE 4 (severe, life-threatening)
  • Extreme limitation in activity, significant assistance required, significant medical intervention/therapy required, hospitalization or hospice care
  • Discontinue all ARV drugs, manage medical event until patient stable and toxicity resolved



Complications of Therapy



Opportunistic Infections

Organ System


Antimicrobial Agents




Zambia HIV National Guidelines


Antiretroviral Therapy

Laboratory Testing







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