ART Guidelines

ART Guidelines

Please review the disclaimer before proceeding with these guidelines



  • ×
    /r ritonavir-boosted
    3TC lamivudine
    ABC abacavir
    ADR adverse drug reaction
    AKI acute kidney injury
    ALT alanine transaminase
    ANC antenatal care
    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
    CNS central nervous system
    CrAg cryptococcal antigen
    CrCl creatinine clearance rate
    CSF cerebrospinal fluid
    CTX cotrimoxazole
    d4T stavudine
    ddI didanosine
    DILI drug-induced liver injury
    DNA deoxyribonucleic acid
    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
    FTC emtricitabine
    GI gastrointestinal
    Hb haemoglobin
    HBsAg hepatitis B surface antigen
    HBV hepatitis B virus
    HIV human immunodeficiency virus
    ICU intensive care unit
    INH isoniazid
    INR international normalised ratio
    InSTI integrase strand transfer inhibitor
    IPT isoniazid preventive therapy
    IRIS immune reconstitution inflammatory syndrome
    LAM lipoarabinomannan
    LDL-C low-density lipoprotein cholesterol
    LFT liver function test
    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
    PAS p-aminosalicylic acid
    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
    QTc corrected QT interval
    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
    UDP uridine 5’-diphospho
    ULN upper limit of normal
    VL viral load
    WHO World Health Organization
    WOCP women of childbearing potential

    Laboratory monitoring of the efficacy and safety of antiretroviral therapy

    In patients on TDF who are admitted to hospital, it is important to assess creatinine even if it does not fall within these monitoring guidelines. This is because intercurrent illnesses with dehydration or sepsis may be associated with deterioration in renal function, in which TDF may act as a co-factor.

    Table 18 lists the laboratory investigations and their frequency advised for monitoring of ART safety.

    Tip: To best view this table, zoom in or rotate your mobile device into landscape orientation.

    TABLE 18: Standard laboratory monitoring of patients after commencement of antiretroviral therapy.
    Test When Comments
    Baseline Ongoing
    VL Yes At 3 months, 6 months and then 6-monthly If VL undetectable for > 12 months, then can reduce to 12-monthly.
    CD4+ count Yes 6-monthly; and at virological/clinical failure Can be stopped if CD4+ count > 200 cells/μL and virologically suppressed.
    FBC and differential count Yes Monthly for the first 3 months, then at 6 months for patients on AZT-containing regimens

    This test is only required for patients commencing AZT-containing regimens.

    ALT Yes At initiation If baseline ALT is normal, then routine monitoring of ALT is not required.
    CrCl Yes At 3 months, 6 months and then 6-monthly Also at 1 month and 2 months in high-risk patients. If there are symptoms of tubular wasting (e.g. muscle weakness), then check potassium and phosphate levels.
    TC and TG Not routinely After 3 months on a PI-containing regimen If normal at 3 months, then reassess only if other cardiovascular risk factors are present.

    ALT, alanine transaminase; AZT, zidovudine; CrCl, creatinine clearance rate; FBC, full blood count; NVP, nevirapine; TC, total cholesterol; TG, triglycerides; VL, viral load.
    †, These tests should also be performed when clinically indicated, based on the discretion of the clinician.

    Common pitfall: Monitoring of VL is not performed at least annually. This results in delayed detection of ART failure and intervention, with resultant clinical deterioration and increased risk of transmission.