First-line ARV Regimens

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Presentation transcript:

First-line ARV Regimens PATIENT CATEGORY PREFERRED REGIMEN ALTERNATIVE REGIMEN 1. Adults and adolescents aged ≥10 years and ≥35kg 1.1. Adult men and adolescent boys 1.2. Adult women and adolescent girls on effective contraception3 1.3. Adult women and adolescent girls not of child bearing potential TDF+3TC+DTG If DTG is contraindicated1: TDF+3TC+EFV If TDF is contraindicated2: ABC+3TC+DTG 1.4. Adult women and adolescent girls of child bearing potential who are pregnant, intend to get pregnant or not on effective contraception4 TDF+3TC+EFV If EFV is contraindicated: TDF+3TC+ATVr If TDF is contraindicated2: ABC+3TC+EFV 2. Children aged 0-<10 years and <35kg 2.1. Children <3 months ABC+3TC+LPV/r(syrup) 5 ABC+3TC+RAL 2.2. Children ≥3 months to <3 years of age ABC+3TC+LPV/r(pellets) 5 2.3. Children ≥3 years to <10 years old ABC+3TC+LPV/r(tablets) 5 ABC+3TC+DTG or ABC+3TC+RAL Contraindications for DTG Patients taking anticonvulsants; Carbamazepine, Phenytoin, Phenobarbital. Both DTG and EFV are contraindicated in patients taking anticonvulsants, these patients should be given a Protease Inhibitor based regimen Use DTG with caution if a patient is diabetic and taking Metformin. 2. Contraindications for TDF Renal disease and/or GFR <60ml/min Weight<35kg – TLD can be used in adolescents weighing more than 30kg but must weigh benefit of simplified regimen with risk of potential decrease in bone mineral density from TDF component. 3. Effective contraception implies consistent and reliable contraceptives: can include condoms + hormonal contraceptives, tubo-ligation, vasectomy, implants and IUDs. 4. Women of childbearing potential not on effective contraception should be given information and counseled about the potential benefits and risks of DTG, including the benefit of improved viral suppression and the risk of potential birth defects, to allow for an informed decision on their ART regimen and contraceptive choices. 5. Change the formulation of LPV/r from syrup to pellets at 3 months of age and from pellets to tablets at 3 years of age (or as soon as the child is able to swallow the pellets or tablets)

Failing first-line regimens Population Failing first-line regimens Second-line regimens Adults, pregnant and breastfeeding women and adolescents TDF + 3TC + EFV AZT+3TC+ATV/r (recommended) or AZT+3TC+LPV/r (alternative) TDF + 3TC + DTG ABC+ 3TC+ DTG ABC+ 3TC+ EFV ABC/3TC/NVP TDF/3TC/NVP AZT/3TC/NVP AZT/3TC/EFV TDF+3TC+ATV/r (recommended) TDF+3TC+LPV/r (alternative) TDF/3TC/ATVr AZT/3TC/DTG Children 3–<10years ABC + 3TC + EFV AZT+3TC+DTG or AZT+3TC+LPV/r ABC+ 3TC + NVP AZT+3TC+NVP ABC+3TC+DTG or ABC+3TC+LPV/r AZT+3TC+LPV/r ABC+3TC+DTG or ABC+3TC+RAL ABC/3TC/LPV/r AZT+3TC+DTG or AZT+3TC+RAL Children under 3 years ABC+3TC+LPV/r pellets AZT+3TC+RAL AZT+3TC+LPV/r pellets ABC+3TC+RAL ABC+3TC+LPV/r 1-All PLHIV should receive resistance testing to inform the prescription of 3rd-line medicines. 2-Since all 3rd-line PLHIV will have prior PI Exposure, DRV/r will be 600/100mg taken twice a day.