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close this bookNational Guidelines for the Clinical Management of HIV/AIDS - Tanzania (NACP; 2005; 131 pages)
View the documentLIST OF ABBREVIATIONS
View the documentACKNOWLEDGEMENTS
View the documentFOREWORD
Open this folder and view contentsCHAPTER 1: INTRODUCTION
Open this folder and view contentsCHAPTER 2: ORGANIZATION OF HIV/AIDS CARE AND TREATMENT
Open this folder and view contentsCHAPTER 3: HIV/AIDS PREVENTION
Open this folder and view contentsCHAPTER 4: PROTECTIVE MEASURES AGAINST HIV TRANSMISSION
Open this folder and view contentsCHAPTER 5: LABORATORY TESTS IN HIV/AIDS
Open this folder and view contentsCHAPTER 6: HIV/AIDS AND PREGNANCY
Open this folder and view contentsCHAPTER 7: PEDIATRIC HIV/AIDS AND RELATED CONDITIONS
Open this folder and view contentsCHAPTER 8: COMMUNITY AND HOME BASED CARE FOR PEOPLE LIVING WITH HIV/AIDS (PLHA)
Open this folder and view contentsCHAPTER 9: COUNSELLING RELATED TO HIV-TESTING AND TREATMENT ADHERENCE
Open this folder and view contentsCHAPTER 10: MANAGEMENT OF COMMON SYMPTOMS AND OPPORTUNISTIC INFECTIONS IN HIV/AIDS
Open this folder and view contentsCHAPTER 11: MANAGEMENT OF MENTAL HEALTH PROBLEMS IN HIV/AIDS
close this folderCHAPTER 12: MANAGEMENT OF HIV INFECTED PATIENTS USING ANTIRETROVIRAL DRUGS
View the document12.1 Introduction
Open this folder and view contents12.2 Types of Antiretroviral drugs
Open this folder and view contents12.3 Treatment using ARV drugs in adults and adolescents
close this folder12.4 Recommended ARV drugs in Tanzania
View the document12.4.1 Introduction
View the document12.4.2 First line ARV combination regimen for adults and adolescent ART naive patients
View the document12.4.3 Women of Childbearing Potential or Pregnant Women
View the document12.4.4 Antiretroviral drugs for non-ART naïve patients
Open this folder and view contents12.5 Adherence to Antiretroviral Therapy
Open this folder and view contents12.6 Changing of Antiretroviral Therapy
View the document12.7 Second-Line ARV Regimen
Open this folder and view contents12.8 Monitoring Patients on ARV Therapy.
Open this folder and view contents12.9 Laboratory Monitoring of patients on second line drugs
Open this folder and view contents12.10 Treatment failure with second line regimen
View the document12.11 Contraindications (relative) for initiation of ART
View the document12.12 Discontinuation of ART
Open this folder and view contentsCHAPTER 13: ARV THERAPY IN INFANTS AND CHILDREN
Open this folder and view contentsCHAPTER 14: USE OF ARVS IN SPECIAL CIRCUMSTANCES
Open this folder and view contentsCHAPTER 15: HIV/AIDS AND NUTRITION
Open this folder and view contentsCHAPTER 16: MANAGEMENT OF ANTIRETROVIRAL MEDICINES
Open this folder and view contentsCHAPTER 17: CERTIFICATION OF HEALTHCARE FACILITIES AS CARE AND TREATMENT SITES
 

12.4.2 First line ARV combination regimen for adults and adolescent ART naive patients

The MoH recommends four different combinations of drugs for adults and adolescents. The combinations will be used according to indications and contraindications that govern the use of ARVs to minimize side effects and drug-drug interactions.

I Stavudine (d4T)+Lamivudine (3TC)+Nevirapine (NVP) Fixed Dose Combination (FDC) for example Triomune 30 or 40 depending on body weight < or > 60 kg. respectively


This is the default drug to prescribe for all patients.

It is important to note that Nevirapine challenge dosing is required during the beginning of treatment. Consequently, the one FDC tablet should be taken in the morning, then only d4T and 3TC tablets in the evening for the first 2 weeks of treatment. d4T+3TC+NVP (FDC) as Triomune 30 or 40 o.d. in morning for first 2 weeks

Stavudine 30 or 40 mg/Lamivudine 150 mg o.d. in the evening for first 2 weeks

THEN after 2 weeks, if well (no rash tolerated), continue at full dose (d4T+3TC+NVP (FDC) as Triomune 30 or 40 twice daily). Advisable to check LFT at this stage.

II Zidovudine (AZT)+Lamivudine (3TC)+Nevirapine (NVP)


Again, it is important to note that Nevirapine challenge dosing is required during the beginning of treatment. Consequently, the Nevirapine/AZT/3TC (or Nevirapine containing FDC) should be taken in the morning, and only AZT/3TC in the evening for the first 2 weeks of treatment.

Zidovudine 300 mg/Lamivudine 150 mg/Nevirapine 200 mg o.d. in morning for first 2 weeks

Zidovudine 300 mg/Lamivudine 150 mg o.d. in the evening for the first 2 weeks

THEN after 2 weeks, if well, (no rash) continue at full dose (Zidovudine 300 mg/Lamivudine 150 mg/Nevirapine 200 mg twice daily). Advisable to check LFT at this stage.

Note:For adolescents, AZT is 200 mg 12 hourly for body wt 20-40 kg.

III Stavudine (d4T)+Lamivudine (3TC)+Efavirenz (EFV)


Stavudine 40 mg/Lamivudine 150 mg twice daily and Efavirenz 600 mg once daily at night (> 60 kg weight).

Stavudine 30 mg/Lamivudine 150 mg twice daily and Efavirenz 600 mg once daily at night (< 60 kg weight).

Note: For <40kg body weight, EFV dose should be <600mg.

IV Zidovudine (AZT)+Lamivudine (3TC)+Efavirenz (EFV)


Zidovudine 300 mg/Lamivudine 150 mg twice daily and Efavirenz 600 mg once daily at night.

Note:

For adolescents, AZT is 200 mg bd for body wt 20-40 kg.

 

For <40kg, EFV dose should be <600mg.

Nb: It is best to verify all doses based on body weight..

1st line Regimen in Tanzania

Unless contraindicated, all patients will commence therapy on: d4T+3TC+NVP

However patients can be started on:

- AZT+3TC+NVP if there is peripheral neuropathy
- d4T+3TC+EFV if there is TB and anaemia <7.5gm/dl
- AZT+3TC+EFV if there is TB, and no anaemia


Figure 6: Recommended First line drug regimen in Tanzania

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