1. 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)

2. 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.