Zambian HIV Guidelines:: When to Start ARV Therapy for Chronic HIV Infection in Adults and Adolescents

	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 and Jabbin Mulwanda MMed FCS

When to Start ART in Adults and Adolescents

04-10-2008

Adults and Adolescents with Documented HIV Infection

WHO stage I*:
CD4 available: use CD4-guided criteria (see below)
CD4 not available: do not treat
WHO stage II:
CD4 available: use CD4-guided criteria
CD4 not available: treat if total lymphocyte count <1200 (CD4 count strongly recommended)
WHO Stage III:
CD4 available: treat if CD4 <350. If CD4 >350, treat if >1 stage 3 sign or repeated stage 3 problem
CD4 not available: treat
WHO Stage IV: treat regardless of CD4
*For WHO clinical stages of see WHO Clinical Staging of HIV Disease in Adults and Adolescents

CD4 Criteria for Initiation of ART

CD4 <200: Treat regardless of clinical stage
CD4 200-350: Treat if WHO stage III or pregnancy
CD4 >350: Treat if >1 stage III sign or repeated stage III conditions. For others, monitor and consider ART based on clinical or immunologic deterioration. Always start before CD4 decreases to <200.
Measure CD4 after stabilization of any intercurrent illness.

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