The regime described below is for treatment (patients who have not previously been treated with ART) individuals and is based on evidence from other ART programmes worldwide. The recommendations are based on the effectiveness of the drug, pill burden, toxicity, dosing frequency, food requirements, convenience and drug interaction profiles, resistance to ARV, availability and cost.
The regimen is based on triple therapy. Monotherapy or Dual therapy are contraindicated.
The following triple therapy regimen are recommended
• 2 Nucleoside reverse transcriptase inhibitors (NRTIs) and 1 Protease Inhibitor (PI)
• 2 NRTIs and 1 Non-nucleoside reverse transcriptase inhibitors (NNRTI)
• 2 NRTIs and 2 Pls
One drug/combination is chosen from group A and one form group B
| |
Column A |
Column B |
FIRST LINE DRUGS |
Efavirenz |
Stavudine + Lamivudine |
| |
Nevirapine* (as single dose for Prevention for mother to child transmission) |
Stavudine + Didanosine |
| |
|
Zidovudine + Lamivudine |
| |
|
Zidovudine + Didanosine |
SECOND LINE DRUGS** |
Nevirapine (as part of triple therapy) |
As in column B above |
| |
Indinavir |
|
| |
Nelfinavir |
|
* Nevirapine single dose therapy is being used for the prevention of mother to child transmission programme alone.
** Second line drugs may be used in individuals who fit the criteria for change of therapy. Preferably the whole regimen should be changed if the patient fits this criteria.
Drug |
Adult dosage |
Dosage for children |
Adverse effects Minor, frequent |
Adverse effects serious, dose limiting |
Special instructions |
Zidovudine (AZT) |
300 mg bid |
160 mg/m2 8 hourly |
Nausea
Headache
Fatigue
Muscle pains |
Anaemia, Neutropenia, gastrointestinal intolerance, Lactic acidosis |
Caution in: pre-existing anaemia Liver and renal insufficiency |
Didanosine (DDI) |
Greater then 60 kg 200 mg bid or 400 mg daily Less than 60 kg 125 mg bid of 250 mg daily |
90 - 150 mg/m2 12 hourly |
Neuropathy
Nausea
Diarrhoea dry mouth |
pancreatitis, Lactic Acidosis |
Take food One hour before or after food Contains antacid, affects absorption of other drugs |
Zalcitabine (ddC) |
0.75 mg tid |
0.005-0.01 mg/kg 8 hourly |
Peripheral neuropathy, mouth ulcer |
Pancreatitis Lactic acidosis |
|
Lamivudine (3TC) |
150 mg bid |
4 mg/kg 12 hourly |
Few side effects, neutropenia, peripheral neuropathy reported |
Lactic acidosis |
|
Stavudine (d4T) |
20 - 40 mg twice daily |
1 mg/kg 12 hourly |
Peripheral neuropathy |
Lactic acidosis |
Caution in liver insufficiency |
Abacavir |
300 mg tid |
8 mg/kg bid |
Nausea
Poor appetite
Vomiting
Fatigue
Sleep disturbance |
Hypersensitivity reaction
Lactic acidosis |
Caution in liver or renal disease Discontinue use in symptoms of hypersensitivity |
Nelfinavir (NFV) |
750 mg tid or 1250 mg bid |
30 mg/kg tid |
|
|
|
Indinavir (IDV) |
800 mg 8 tid |
350 -500 mg/m2 12 hourly |
Nausea,
Abdominal pain,
Headache |
Kidney stones
Hyperglycaemia
Lypodystrophy
Abnormal bleeding |
Take on an empty stomach
Drink 1.5 litres of liquid per day to avoid kidney problems
Report loin pain or blood in urine |
Ritonavir (RTV) |
600 mg bid |
400 mg mg/m2 12 hourly |
Gastrointestinal tolerance first 2 to 4 weeks.
Weakness
Skin sensitivity
Peri oral tingling and numbness
Change in taste |
Abnormal liver function tests.
Major drug interactions
Hyperglycaemia
Lypodystrophy
Abnormal bleeding |
Capsule require refrigeration
Easier tolerated if taken with food |
Saquinavir |
600 mg tid |
50 mg/kg tid |
Few reported side effects
Should be used as potentiated PI in conjunction with Ritonavir |
Diarrhoea
Nausea
Abnormal LFTS |
Take high fat meal
Refrigeration for long term storage
Caution in liver disease |
Efavirenz |
600 mg daily |
|
Skin rash
Abnormal Liver function test |
Neuropsychiatric disturbances |
Caution in liver disease |
Nevirapine |
200 mg daily x 14 then 200 mg b.d |
|
Skin rash
Abnormal liver function tests |
Hepatitis |
Caution in liver disease |
