A 27-year old female is referred to your clinic due to persistently detectable viral load. She has been on antiretroviral therapy (ART) – tenofovir (TDF), lamivudine (3TC), and efavirenz (EFV) – for 22 months. Her clinic file documents that she had early problems with neuropsychological side-effects of EFV (drowsiness and dizziness) and subsequent adherence problems. However, she now reports good adherence (>95%). She also reports social and financial difficulties. Her family and partner did not support her in taking ART and she has moved in with her sister who is also HIV-infected but not yet on ART. She has admitted to having used traditional medicines whilst on ART.
The results of viral load and CD4+ cell count monitoring are displayed in the table.
CD4+ cell count (cells/µL)
HIV RNA (copies/ml)
Baseline
94
-
7 months
26
8,236
11 months
97
3,283
15 months
15,053
22 months
10
7,589
Question 1: What is the current criterion for switch to second-line antiretroviral therapy in the South African Department of Health guidelines for adults and adolescents?
