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SOUTHERN AFRICAN HIV CLINICIANS SOCIETY
SAHCS GUIDELINES FOR ANTIRETROVIRAL THERAPY
GUIDELINES
IN ADULTS: 2020 UPDATE

TABLE OF CONTENTS
What’s new in the 2020 guidelines update? 4
Abbreviations 5
1. 2. NRTI Preamble 6 7
Nucleoside/nucleotide reverse transcriptase inhibitor class of antiretroviral drugs
NOW DIGITISED AND MORE USER FRIENDLY 3. 4. 5. InSTI NNRTI Integrase strand transfer inhibitor class of antiretroviral drugs 11 14 17
Non-nucleoside reverse transcriptase inhibitor class of antiretroviral drugs
Protease inhibitor class of antiretroviral drugs
SAHCS
GUIDELINES 6. 7. PI Initiation and timing for antiretroviral therapy 19 23
Baseline investigations
8. Viral load 24
9. CD4 + cell count 26
SOUTHERN AFRICAN HIV CLINICIANS SOCIETY 10. 11. Resistance and genotyping 28 32
Initial antiretroviral therapy regimens for the previously untreated patient
GUIDELINES FOR ANTIRETROVIRAL THERAPY 12. Management of patients currently receiving first-line therapy 34
IN ADULTS: 2020 UPDATE 13. Management of patients starting or currently receiving second-line therapy 37
14. Third-line antiretroviral therapy 40
15. 16. Laboratory monitoring of the efficacy and safety of antiretroviral therapy 43 44
The Adult Treatment guidelines are now available in a 17. 18. Drug-drug interactions 46 48
Patients who return after stopping antiretroviral therapy
Tuberculosis
digital format, with easy navigation and search func- 19. 20. 21. Pregnancy and breastfeeding 51 54 56
Liver disease
Renal disease
tionality. Clinical treatment guidelines are also available 22. 23. 24. 25. Psychiatric disease 58 59 61 63
Malaria
Antiretroviral drug-induced liver injury
Dyslipidaemia
in a downloadable format with infographics to improve 26. 27. 28. 29. Immune reconstitution inflammatory syndrome 65 67 69 71
Opportunistic infection prophylaxis
Adherence
access and support quick clinical decision-making. References 83
Useful algorithms and summaries
1 | Adult ART Guidelines 2020 3 | Adult ART Guidelines 2020
A publication of the Southern African HIV Clinicians Society
The guidelines, including a host of other related (clinical) information, can be accessed via
www.sahivsoc.org under the Resources section.
TREATMENT OPTIMISATION
AND ADVANCED HIV DISEASE
ONLINE COURSE
TREATMENT
OPTIMISATION
HIV treatment optimisation is a process intended to enhance the long-
term efficacy, adherence, tolerability, safety, convenience, and affordability
of combination antiretroviral therapy. The ultimate goal is to expand access
to well tolerated and effective lifetime treatment to all those in need.

Learn from South Africa’s HIV Experts using online training - anywhere, anytime, any device.
21 CPD points. Course is fully subsidised.

The 8 modules are as follows:
• Dolutegravir in SA (TO & TLD): Prof. Francois Venter, • ART initiation in AHD: Prof. Sipho Dlamini
Dr. Jeremy Nel, Mr. Luckyboy Mkhondwane • Cryptococcal Meningitis: 4-hour stand-alone
• TLD eligibility: Guidelines: Dr. Jeannette Wessels course: Dr. Nelesh Govender, Prof. Yunus Moosa
• Using new ARVs in TB: Dr. Sean Wasserman, Dr. & Dr. Richard Lessells (see below for more
Ndiviwe Mphothulo information).
• Using new ARVs in pregnancy: Prof Linda-Gail • TB & other respiratory opportunistic infections: Prof.
Bekker, Dr Coceka Mnyani; plus Update on new Gary Maartens, Prof. Yunus Moosa & Dr. Richard Lessells
paediatric ARV formulations -present and future: • HIV/TB & Covid-19: Dr. Mary-Ann Davies, Prof Graeme
Dr. Leon Levin Meintjes

Advanced HIV Disease (AHD) is defined as the presence of a CD4 cell count <100 (SAHIVCS Cryptococcal
Meningitis update 2019) - 200cells/ mm or a WHO clinical stage 3 or 4 event, for adults, adolescents, and
3
children ≥5 years old. This results in a high risk of mortality and morbidity, which is worse, the lower the CD4
count. On initiating ART, there is less robust CD4 recovery. Finally, there is a high risk of opportunistic infections
(OIs). All children < 5 years old with HIV infection are considered as having advanced HIV disease.

For more information contact [email protected]
HIV Nursing Matters | June 2021 | page 7