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7 Private Practice Medical What is new in the 2020 guidelines update?
Adviser, Johannesburg, Key updates
South Africa
ÿ A recommendation for dolutegravir (DTG)-based therapies as the preferred first-line
8 Department of Medicine,
Division of Clinical antiretroviral therapy (ART) option (section 11).
Pharmacology, University of ÿ Updated guidelines for second- and third-line ART regimens (section 13).
Cape Town, Cape Town, ÿ New recommendations on the management of patients on DTG-based therapies who have an
South Africa elevated viral load (section 12).
ÿ A lowering of the threshold for virological failure from 1000 copies/mL to 50 copies/mL
9 Department of Internal
Medicine, School of (section 8).
+
Medicine, Pietersburg ÿ A recommendation against routine cluster of differentiation 4 (CD4 ) monitoring in patients
Hospital, Polokwane, South who are clinically well once the CD4 count is > 200 cells/μL (section 9).
+
Africa
ÿ Updated recommendations for isoniazid preventive therapy (IPT) in human immunodeficiency
virus (HIV)-positive patients (section 27).
10 Department of Medicine,
School of Medicine, ÿ A recommendation for the use of low-dose prednisone as prophylaxis for paradoxical
University of Limpopo, tuberculosis (TB) immune reconstitution inflammatory syndrome (IRIS) in TB/HIV co-infected
Turfloop, South Africa patients commencing ART within 1 month of TB therapy (section 26).
11 Private Practice,
Vereeniging, South Africa 1. Preamble
Key principles
12 Department of Infectious
Diseases, Division of Internal Although many antiretroviral therapy (ART) guidelines are available internationally, the current
Medicine, University of guidelines have been written to address issues relevant to southern Africa. A major spur for the
KwaZulu-Natal, Durban, current guidelines is the introduction of dolutegravir (DTG) into first- and second-line ART
South Africa
regimens. Dolutegravir-based ART regimens hold much promise, although the transition
13 Private Practice (Phomolong inevitably challenges existing paradigms and generates additional complexities. These guidelines
Medical Centre), Rustenburg, aim to address many of these and to update the text in general to reflect the latest evidence.
South Africa
As with previous iterations, these guidelines take affordability into account, as countries in the
14 Reproductive Health and region vary according to their low- and middle-income status. Hence, only the treatment and
HIV Institute, Faculty of
Health Sciences, University of diagnostic options that are available in southern Africa are included. In addition, these
the Witwatersrand, guidelines recognise the need to bridge the gap in treatment recommendations between public
Johannesburg, South Africa and private sector programmes, considering that many patients transition between the two
sectors for treatment. The format of this iteration of the guidelines has been modified to
15 Specialist Family Physician,
Amathole District Clinical highlight each section’s key points and common pitfalls. It will also be released over time as
Specialist Team, East London, multiple stand-alone modules, designed with an emphasis on readability, ease of access and
South Africa user-friendliness.

16 Department of Infectious
Diseases, Faculty of Goals of antiretroviral therapy
Medicine, Sefako Makgatho The goals of ART are to:
Health Sciences University,
Pretoria, South Africa • provide maximal and durable suppression of viral load (VL)
• restore and/or preserve immune function
17 Department of Medicine, Dr • reduce human immunodeficiency virus (HIV)-related infectious and non-infectious
George Mokhari Hospital, morbidity
Pretoria, South Africa
• prolong life expectancy and improve quality of life
18 Department of Medical • prevent onward transmission of HIV
Virology, National Health • minimise adverse effects of the treatment
Laboratory Service,
Tygerberg, South Africa 20 Clinical HIV Research Unit, Wits Health Consortium, Johannesburg, South Africa
21 Department of Medicine, Faculty of Infectious Diseases, Frere and Cecilia Makiwane Hospitals, East London, South Africa
19 Department of Pathology, 22 Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
Faculty of Medicine and 23 Department of Internal Medicine, Military Hospital, Bloemfontein, South Africa
Health, Stellenbosch 24 Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
University, Cape Town, 25 Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
South Africa Corresponding author: Jeremy Nel, [email protected]
Dates: Received: 18 June 2020 | Accepted: 21 June 2020 | Published: 16 Sept. 2020 | Republished: 30 Apr. 2021
How to cite this article: Nel J, Dlamini S, Meintjes G, et al. Southern African HIV Clinicians Society guidelines for antiretroviral therapy in
adults: 2020 update. S Afr J HIV Med. 2020;21(1), a1115. https://doi.org/10.4102/sajhivmed.v21i1.1115
Copyright: © 2020. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.
Note: This article was republished as a second edition. The publisher apologises for any inconvenience caused.

http://www.sajhivmed.org.za 20 Open Access