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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
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
 

12.7 Second-Line ARV Regimen

Before treatment failure is presumed and a particular regimen discarded, every effort should be made to rule out causes other than drug resistance. Patients should be evaluated for correctable factors, such as:

Inappropriate dosing schedules,

Drug interactions that may reduce the efficacy of some of the ARV,

Non adherence due to side effects, and

Evidence of malabsorption.

Each of the above scenarios could result in sub-therapeutic drug levels and poor clinical response. In such cases, the regimen in question may be salvaged with palliative medication and/or patient education. If clinical assessment indicates the presence of treatment failure due to confirmed drug resistance, then the best approach is to switch to an entirely new regimen, choosing two or more drugs to which the patient is naïve as the second line drug regimen. Before changing to the second line drug regimen, the patient should go through the treatment readiness and education process again. This would need to be carefully monitored as some patients might hide their non-adherence.

Second-line antiretroviral therapy in adults and adolescents

The second line regimen for adults and adolescents includes the following drug combinations:

Abacavir 300 mg twice daily/Lopinavir/ritonavir 133.3/33.3 mg (Kaletra) 3 tablets twice a day and didanosine 200 mg. two tablets a day on an empty stomach

Note: ddI is easier to dose at 250-300 mg od for wt < 60 kg and 400 mg od for body wt > 60 kg.

Alternatively the following regimen can also be used:

Abacavir (ABC) 300 mg twice daily//Saquinavir/ritonavir (SQV 5X 200 mg or 1000 mg bd plus RTV one 100 mg cap bd) and didanosine 200 mg. two tablets a day

Note: ddI is easier to dose at 250-300 mg od for wt < 60 kg and 400 mg od for body wt > 60 kg.\

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