Zambian HIV Guidelines:: Stopping ARV Therapy

	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

Stopping ARV Therapy

05-06-2008

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.)

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