Southern African HIV Clinicians Society

ART Guidelines

Last updated 13 June 2023

Please review the disclaimer before proceeding with these guidelines

Table of Contents How to use these guidelines Abbreviations MODULES 1. What’s new the 2023 guidelines update? 2. Nucleoside/nucleotide reverse transcriptase inhibitor class of antiretroviral drugs 3. Integrase strand transfer inhibitor class of antiretroviral drugs 4. Non-nucleoside reverse transcriptase inhibitor class of antiretroviral drugs 5. Protease inhibitor class of antiretroviral drugs 6. Initiation and timing of antiretroviral therapy 7. Baseline investigations 8. Viral load 9. CD4⁺ cell count 10. Resistance and genotyping 11. Initial antiretroviral therapy regimens for the previously untreated patient 12. Management of patients currently receiving first-line therapy 13. Management of patients starting or currently receiving second-line therapy 14. Third-line antiretroviral therapy 15. Laboratory monitoring of the efficacy and safety of antiretroviral therapy 16. Patients who return after stopping antiretroviral therapy 17. Drug-drug interactions 18. Tuberculosis 19. Pregnancy and breastfeeding 20. Liver disease 21. Renal disease 22. Psychiatric disease 23. Malaria 24. Antiretroviral drug-induced liver injury 25. Dyslipidaemia 26. Immune reconstitution inflammatory syndrome 27. Opportunistic infection prophylaxis 28. Adherence
References

ABBREVIATIONS

/r	ritonavir-boosted
3TC	lamivudine
ABC	abacavir
ADR	adverse drug reaction
AKI	acute kidney injury
ALT	alanine transaminase
ART	antiretroviral therapy
ARV	antiretroviral
AST	aspartate transaminase
ATV	atazanavir
ATV/r	ritonavir-boosted atazanavir
AZT	zidovudine
bd	twice daily
CD4⁺	cluster of differentiation 4
CM	cryptococcal meningitis
CrAg	cryptococcal antigen
CrCl	creatinine clearance rate
CSF	cerebrospinal fluid
CTX	cotrimoxazole
CVS	cardiovascular
d4T	stavudine
DILI	drug-induced liver injury
DNA	deoxyribonucleic acid
DOR	doravirine
DRV	darunavir
DRV/r	ritonavir-boosted darunavir
DTG	dolutegravir
eGFR	estimated glomerular filtration rate
ELISA	enzyme-linked immunosorbent assay
ETR	etravirine
FBC	full blood count
FDC	fixed dose combination
FTC	emtricitabine
GI	gastrointestinal
Hb	haemoglobin
HBsAg	hepatitis B surface antigen
HBV	hepatitis B virus
HIV	human immunodeficiency virus
ICU	intensive care unit
InSTI	integrase strand transfer inhibitor
IPT	isoniazid preventive therapy
LAM	lipoarabinomannan
LDL-C	low-density lipoprotein cholesterol
LP	lumbar puncture
LPV	lopinavir
LPV/r	ritonavir-boosted lopinavir
MDRD	modification of diet in renal disease
MTCT	mother-to-child transmission of HIV
MVC	maraviroc
NGT	nasogastric tube
NNRTI	non-nucleoside reverse transcriptase inhibitor
NRTI	nucleoside reverse transcriptase inhibitor
NTDs	neural-tube defects
NtRTI	nucleotide reverse transcriptase inhibitor
NVP	nevirapine
OI	opportunistic infection
PCR	polymerase chain reaction
PI	protease inhibitor
PI/r	ritonavir-boosted protease inhibitor
PMTCT	prevention of mother-to-child transmission of HIV
PPIs	proton pump inhibitors
PrEP	pre-exposure prophylaxis
PWH	people with HIV
RAL	raltegravir
RCTs	randomised controlled trials
RIF	rifampicin
RFB	rifabutin
RNA	ribonucleic acid
RPV	rilpivirine
RTV or /r	ritonavir
sCr	serum creatinine
sCrAg	serum cryptococcal antigen
TAF	tenofovir alafenamide
TAM	thymidine analogue mutation
TB	tuberculosis
TB-IRIS	tuberculosis immune reconstitution inflammatory syndrome
TBM	tuberculosis meningitis
TC	total cholesterol
TDF	tenofovir disoproxil fumarate
TG	triglycerides
TST	tuberculin skin test
ULN	upper limit of normal
VL	viral load
VTP	vertical transmission prevention of HIV
WHO	World Health Organization

SOUTHERN AFRICAN HIV CLINICIANS SOCIETY GUIDELINES FOR ANTIRETROVIRAL THERAPY IN ADULTS: 2023 UPDATE

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Authors: Jeremy Nel, Graeme Meintjes, Regina Osih (Chairpersons), Larisse Badenhorst, John Black, Rosie Burton, Nomathemba Chandiwana, Francesca Conradie, Natasha Davies, Mariam Edoo, Ute Feucht, Cloete Jansen Van Vuuren, John Joska, Richard Lessells, Gary Maartens, Pheto Mangena, Thandekile Manzini, Yunus Moosa, Ndiviwe Mphothulo, Jennifer Nash, Dulcy Rakumakoe, Evan Shoul, Phumla Sinxadi, David Spencer, Helen van der Plas, Camilla Wattrus, Jeannette Wessels, Joana Woods, Jarrod Zamparini (Authors in alphabetical order by surname)

Corresponding author: Jeremy Nel, [email protected]

Disclaimer: Specific recommendations provided here are intended only as a guide to clinical management, based on expert consensus and best current evidence. Treatment decisions for patients should be made by their responsible clinicians, with due consideration for individual circumstances. The most current version of this document should always be consulted.

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