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Table 2 Key recommendations from the reference guideline for the management of HIV in adults

From: Clinical practice guidelines within the Southern African development community: a descriptive study of the quality of guideline development and concordance with best evidence for five priority diseases

 

WHO 2010

Details

Points

Recommendation 1

When to start

- CD4 count < 350

- WHO Clinical stage 3 and 4 irrespective of CD4 count

2

Recommendation 2

What to start

- AZT+3TC +EFV

- AZT+3TC+NVP

- TDF+3TC/FTC+EFV

- TDF+3TC/FTC+NVP

4

Recommendation 3

ART for HIV/TB

- Start ART in all patients with TB

- Start TB treatment first

- Prefer EFV

- Start ART within 2-8 weeks of starting TB treatment

- If CD4 count < 200, start ART within 2 weeks

5

Recommendation 4

ART for HIV/Hep B

- Start ART in all patients who require treatment for their Hepatitis B

- Start TDF and 3TC/FTC

2

Recommendation 5

ART for pregnancy

- Start ART in all pregnant women if CD4 count < 350

- Start ART in all women with clinical stage 3 or 4 disease irrespective of CD4 count

- AZT preferred in pregnancy

- EFV or NVP can be used

- Do not start EFV in first trimester

6

Recommendation 6

When to switch -

(note: if VL 5000 or less, will be accepted e.g. 1000)

- VL > 5000copies/mL on at least two occasions

- Use CD4 count if VL not available

2

Recommendation 7

Second line ART

(note: if any one of the protease inhibitors included, will accept)

- Boosted PI + 2 NRTIs recommended

- Atazanavir/ritonavir or Lopinavir/ritonavir or darunavir/ritonavir recommended

- If TDF used in first line, use AZT/D4T next

- AND if AZT/D4T used in first line, use TDF in second line

4

  1. ART = antiretroviral therapy; TB = tuberculosis; Hep B = hepatitis B; VL = viral load; PI = protease inhibitor; NRTIs = nucleoside reverse transcriptase inhibitors; TDF = tenofovir; AZT = zidovudine; D4T = stavudine; EFV = efavirenz; NVP = nevirapine