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

05-06-2008

Introduction

Taking antiretroviral therapy (ART) requires long-term commitment from patient. Correct and consistent use required for drugs to be effective. Antiretroviral drugs (ARVs) have side effects that can make them difficult for some patients to take. Thus the decision about when to start therapy is an important one. Treating too early may lead to unnecessary toxicity and premature drug resistance;  treating too late can increase risk of morbidity, mortality, and treatment failure.

Goals of Therapy

  • Reduction of viral load (VL) as much as possible for as long as possible
  • Restoration and/or preservation of immunologic function
  • Improvement of quality of life
  • Reduction of HIV-related illness and death
  • Possible reduction in transmission to others
General principles of ART

  • Use of combinations of at least 3 ARV drugs
  • Maximize adherence to ARV regimen
  • Rational sequencing of ARV drugs
  • Avoid resistance
Prerequisites for administration of ART

  • Appropriate drugs available
  • Drug supply can be sustained
  • Basic clinical and lab measures used to determine need for treatment
  • Basic clinical and lab measures available to monitor for toxicity
  • Patient understands importance of adherence
  • Health care providers trained in use of ART
Indications for Consultation with or referral to an HIV specialist

  • Before initiating or changing ART in
    • Pregnant women or women at risk for pregnancy with CD4 counts 250-350
    • Patients co-infected with viral hepatitis
    • Patients with ALT/AST >5-fold the upper limits of normal range
  • Co-infection with TB if on non-EFV regimen
  • Failure or inability to tolerate second-line therapy or when on other PI-based regimen
  • Severe or life-threatening adverse reactions
  • Before restarting ART after severe or life-threatening adverse reactions
  • Inability to tolerate therapy despite change in regimen
  • Asymptomatic patient wishing to start ART with no CD4 count available or with CD4 >200


Highly Active Antiretroviral Therapy (HAART)

HAART: a combination of at least 3 drugs: namely, any of the following 3 combinations

  • 2 nucleoside reverse transcriptase inhibitors (NRTIs) + 1 non-nucleoside reverse transcriptase inhibitor (NNRTI)
  • 2 NRTIs + 1 protease inhibitor (PI)
  • 3 NRTIs
General Points

  • Goal of HAART: to reduce VL to undetectable levels.
  • HAART must be taken for life.
  • Adherence vital to prevent emergence of resistance.
  • HAART indicated for any patient who meets Zambian National Guideline eligibility criteria.
  • All patients must have confirmed HIV serology and should access counselling services.
  • HAART complements treatment and prophylaxis of opportunistic infections.
  • HAART not an emergency; must be initiated after proper treatment preparation.
  • In case of post exposure prophylaxis (PEP), prophylaxis should be initiated as soon as possible (ideally within 2 hours of exposure).
  • In PMTCT, more urgent prophylaxis needs to be considered to minimize risk of perinatal transmission.
Who should prescribe HAART?


  Health care providers fulfilling following requirements:

  • Legally recognized to prescribe in Zambia
  • Trained in HIV/AIDS management
  • Have access to sustainable drug supply and facilities to monitor therapy
  • Participate in continuous medial education in use and monitoring of ART 

 
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