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
WHAT’S NEW IN THE 2023 GUIDELINES UPDATE?
- Recommendation to shift most patients to a dolutegravir-based regimen if possible (see modules 12-14).
- For patients requiring a protease inhibitor (PI), recommendation for darunavir as the PI of choice, and for lopinavir/ritonavir to only be considered where a PI is required to be coadministered with rifampicin-based tuberculosis treatment (see modules 5 and 13).
- New recommendations on the move away from routine use of zidovudine (AZT) in second-line therapy in favour of recycling tenofovir or, in patients with renal dysfunction, abacavir (see module 13).
- Advice on how to assess the increase in serum creatinine seen with dolutegravir/tenofovir fixed dose therapy (see module 3).
- Guidance on the role of tenofovir alafenamide; TAF (see modules 2 and 11).
- Inclusion of enhanced baseline screening for tuberculosis and sexually transmitted infections (see module 7)
- Expansion of the module on HIV and mental health (see module 22).