Southern African HIV Clinicians Society
Publication Date: January 1, 2017
2017 Southern African HIV Clinicians Society recommendations for the use of antiretroviral therapy in adults with HIV infection. Topics addressed include key principles of antiretroviral therapy (ART); goals of therapy; standard of care; classes of antiretroviral (ARV) agents and their mechanisms of action; ARV agents currently available in Southern Africa, including dose and common adverse drug reactions; indications for starting ART (universal access); benefits of antiretroviral therapy in reducing transmission; starting ART in patients with tuberculosis; starting ART in patients with other opportunistic diseases/infections and acute illnesses; patient readiness for ART; commencing ART at first antiretroviral clinic visit; ART in primary infection; ART initiation in elite controllers; baseline monitoring; initial ARV regimens for the previously untreated patient; laboratory monitoring for ART efficacy; defining ART failure, including virologic criteria for treatment success or failure and CD4+ cell count response; indications for changing ART; second-line ART; third-line ART; stopping ART; patients who return after defaulting therapy; drug interactions; ART in special populations, including patients with TB and pregnant patients; ART choice in pregnancy, breastfeeding, and postnatal period, partner engagement; ARV dosages in renal failure; ART in acute kidney injury; ARV dosages in liver impairment; hepatitis B coinfection; malaria; ARV toxicity monitoring and management; haematological toxicity; hepatotoxicity; hyperlactataemia and lactic acidosis; dyslipidaemia; lipodystrophy; hypersensitivity; nephrotoxicity; neuropsychiatric toxicity; dysglycaemia; gynaecomastia; immune reconstitution inflammatory syndrome; and support and counselling, including ART-related counselling; prophylaxis in patients receiving ART including OI and TB prophylaxis.
Keywords: HIV - Resource-Limited Settings, HIV - First-line Therapy, HIV - Adverse Events, HIV - Tuberculosis, HIV - Cryptococcus, HIV - Acute HIV Infection, HIV - Monitoring, HIV - Switch Strategies, HIV - Treatment-Experienced Patients, HIV - Drug-Drug Interactions, HIV - Special Populations, HIV - Pregnancy, HIV - Viral Hepatitis Coinfection, HIV - Haematologic Complications, HIV - Hepatic Complications, HIV - Dyslipidaemia, HIV - Renal Complications, HIV - Neurologic Complications, HIV - IRIS