Page 33 - Nursing Matters June 2021 Vol 12

clinical guidance
clinical guidance

Clinical tips

1. Counselling on the risks and benefits is essential when 10. Preventing, diagnosing and treating women for TB
initiating dolutegravir (DTG) in women wanting to must receive greater emphasis if maternal and child
conceive now or in the near future. outcomes are to be improved.
2. HIV positive women who are not currently on 11. Any infant with a positive birth HIV PCR should be
antiretroviral therapy (ART) but are ART exposed should referred or discussed telephonically urgently for ART
initiate a DTG-containing regimen. initiation.
3. Initiate all newly diagnosed HIV+ patients on TLD and 12. Do an age-appropriate HIV test at six weeks post
switch those already on TEE (if virally suppressed). cessation of breastfeeding, even if breastfeeding
4. Prioritise switch from TEE to TLD; prescribe multi-month continues for longer than 18 months.
ART and decant eligible patients to external pick-up 13. Universal HIV testing is recommended at 18 months of
sites to limit facility visits during COVID-19. age for ALL infants regardless of HIV exposure except
5. Inform patients of potential drug interactions and new those who are already on ART.
side effects when switching to DTG. 14. A HIV PCR test should be performed at 6 months for all
6. DTG often causes a mild rise in serum creatinine but this HIV exposed infants.
is of no consequence and does not represent a decline 15. HIV exposed but uninfected (HEU) infants may
in renal function. experience poorer outcomes despite being uninfected
7. Family planning and HIV services should always be and should be monitored regularly.
provided together; therefore, offer HIV testing services 16. Pregnant adolescents are at a higher risk for poor
at every family planning visit. adherence and poor viral suppression and require
8. Initiating TLD or DTG in pregnant women beyond 6 more intensive support.
weeks of pregnancy carries no increased risk of neural 17. Because the sensitivity of the TB symptom screening is
tube defects. Counsel the patient about this safety reduced in pregnancy, all pregnant women with HIV
information and allow her to make an informed choice. should be referred for a sputum TB GeneXpert test,
9. The benefits of cotrimoxazole outweigh the risks in regardless of symptoms.
pregnancy in patients with CD4 counts of less than 18. Ensure that any woman diagnosed with TB is adherent
200; or with WHO clinical stage II, III or IV disease. to TB treatment and aware that their newborn may

Abbreviations: ART – antiretroviral therapy; ARV – antiretroviral; CD4 – cluster of differentiation 4; IPT – isoniazid preventive therapy;
PrEP – pre-exposure prophylaxis; TB – tuberculosis; U=U – undetectable = untransmissible; UTT – universal test and treat; VL – viral load.

HIV Nursing Matters | June 2021 | page 31