Southern African HIV Clinicians Society

ART Guidelines

Last updated 09 August 2022

Please review the disclaimer before proceeding with these guidelines

Table of Contents How to use these guidelines Key updates Abbreviations MODULES 1. Preamble 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 29. Useful algorithms
References

ABBREVIATIONS

/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

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

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Authors: Jeremy Nel, Sipho Dlamini, Graeme Meintjes (Chairpersons), John Black, Rosie Burton, Natasha Davies, Eric Hefer, Gary Maartens, Pheto Mangena, Moeketsi Mathe, Michelle Moorhouse, Mahomed-Yunus Moosa, Muhangwi Mulaudzi, Jennifer Nash, Thandekile Nkonyane, Wolfgang Preiser, Mohammed Rassool, David Stead, Helen van der Plas, Cloete van Vuuren, Francois Venter, Joana Woods

Affiliation: Southern African HIV Clinicians Society

Corresponding author: Jeremy Nel

Disclaimer: Specific recommendations provided here are intended only as a guide to clinical management, based on expert consensus and best current evidence. Treatment decisions for patients should be made by their responsible clinicians, with due consideration for individual circumstances. The most current version of this document should always be consulted.

License: These guidelines are licensed under the Creative Commons CC BY-NC-ND 4.0 license. Licensee: Southern African HIV Clinicians Society.

How to cite: Nel J, Dlamini S, Meintjes G, et al.; for the South African HIV Clinicians Society. Southern African HIV Clinicians Society guidelines for antiretroviral therapy in adults: 2020 update. Southern African Journal of HIV Medicine 2020;21(1), a1115. https://sahivsoc.org/ARTGuidelines