ARV management in children ,adolescents and adults 1st line
ART regimens for adults and adolescents
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all new patients needing treatment including pregnant women TDF+FTC(Or 3TC)+EFV FDC preferred
replace EFV with NVP in patients with significant psychiatric co-morbidity or intolerance of EFV and where neuro-psychiatric toxicity of EFV may impair daily functioning e.g shift workers
adolescents
ABC+3TC+EFV at the age of 18 an adolescent , if eligible must e switched to FDC
give TDF+(FTC Or3CT)+NVP use NVP based regimenin ptients with significant co-morbidity or EFV intolerant
contra indications to TDF
contraindication to EFV
AZT+3CT+EFV or NVP renal disease or use of other nephrotoxic drugs e.g aminoglycosides
contraindcation to TDF and AZT
give d4T+3CT+EFV or NVP for renal disease and anaemia or the use of other nephrotoxic drugs
contraindication to TDF,AZT, and d4T
ABC+3TC+EFV or NVP renal disease, anaemia,peripheral neuropathy and the use of nephrotoxic drugs
currently on d4T-based regimen
TDF+FTC or 3CT+EFV FDC preferred manadory if patients expirience toxicity and patients who are highly at risk of toxicity (high BMI or pregnant) switch to TDF if virally supressed and the patience has a normal creatinine clearance ,even if well tolerated
all infants and childreb under 3years or less than 10kg
ABC+3Tc+LPV/r
Currently on d4T-based regimen
change d4T to ABC if viral load is undetectable , if viral load is >1000 copies /ml manage as treatment failure. If viral load is between 50-1000 copies /ml-consult with expect for advice
children over 3 years and over 10kg
ABC+3TC+EFV