Guidelines>Zambia HIV National Guidelines>

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

• 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

• 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

REFERENCED WITHIN THIS GUIDE

• Baseline evaluation and Monitoring
• Changing or Stopping ART
• General Principles of Antiretroviral Therapy for Chronic HIV Infection in Adults and Adolescents
• Initial Regimen for ARV Therapy
• Stopping ARV Therapy