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HIV Guide
 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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Stopping ARV Therapy


Considerations in stopping therapy

  • Patient's inability to tolerate all available ARV medications
  • Patient's request to stop, after appropriate counselling
  • Non-adherence despite counselling: Treatment should be stopped to avoid continued toxicity and continued evolution of drug resistance.
Treatment Failure with No Further Treatment Options

  • Continue failing ART regimen unless toxicities or drug interactions make the clinical situation worse for the patient.
  • ART likely to have residual antiviral activity despite treatment failure.
  • Stopping therapy in setting of virologic failure can be associated with rapid falls in CD4 counts and development of opportunistic complications.
Temporary Discontinuation of ARV Therapy

  • May be needed because of serious drug toxicity, intervening illness or surgery that precludes oral intake, or ARV non-availability
  • Stop ALL the drugs when discontinuing therapy
  • NNRTIs (EFV, NVP) have longer half-lives and may be detected at significant levels for up to 3 wks after last dose; If all components of an NNRTI-based regimen are stopped at the same time, patient will be on functional monotherapy for a period of time and at increased risk for resistance.
  • Consider discontinuing EFV or NVP and continue the NRTIs for 1 additional week, if feasible. (Has demonstrated value in the PMTCT settings, but its benefits in treatment programmes is unclear.)


Complications of Therapy



Opportunistic Infections

Organ System


Antimicrobial Agents




Zambia HIV National Guidelines


Antiretroviral Therapy

Laboratory Testing







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