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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
Open this folder and view contents12.4 Recommended ARV drugs in Tanzania
Open this folder and view contents12.5 Adherence to Antiretroviral Therapy
close this folder12.6 Changing of Antiretroviral Therapy
View the document12.6.1 Changing Antiretroviral therapy because of treatment failure
View the document12.6.2 Changing Antiretroviral therapy because of toxicity
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
 

12.6 Changing of Antiretroviral Therapy

There are multiple reasons which may lead to changing of antiretroviral therapy, including:

Intolerable side effects,

Drug interactions,

First trimester of pregnancy when the patient so elects.

There are no studies and no reliable estimate of the number of days, weeks, or months that constitute a clinically important interruption of one or more components of a therapeutic regimen that would increase the likelihood of drug resistance. If there is a need to discontinue any antiretroviral medication for an extended time, clinicians and patients should be advised of the theoretical advantage of stopping all antiretroviral agents simultaneously, rather than continuing one or two agents, to minimize the emergence of resistant viral strains.

Antiretroviral therapy should be stopped and or changed when there is evidence of:

Toxicity or intolerance to one or all drugs

Failure as evidenced by the patient becoming symptomatic and progressive decline of CD4 count and/or rise of viral load despite good adherence to antiretroviral treatment.

When changing treatment the following should be observed:

Never change a single drug in the combination if the cause of changing is treatment failure, but rather change at least two of the drugs.

If changing due to toxicity, change only the drug suspected to be causing the problem.

Never change to a single drug therapy

In selecting drugs choose drugs that have not been used before, drugs that do not have cross-resistance, and have no overlapping toxicities or drug-drug interactions.

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