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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
close this folder12.8 Monitoring Patients on ARV Therapy.
View the document12.8.1 Clinical and laboratory monitoring of patients on first line drug regimen
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
 

12.8.1 Clinical and laboratory monitoring of patients on first line drug regimen

i. Scheduled visits


Patients will attend the clinic monthly to collect medication and be seen by the professional nurse, Clinical Officer or Assistant Medical Officer to monitor drug tolerance, adverse events and adherence. Ideally the clinic nurse, doctor, pharmacist or therapeutic counsellor should count drugs at each scheduled visit. All patients should be seen by the physician at 2 weeks after initiative to check for adverse events, do more blood tests (ALT or FBC) and to escalate the NVP dose. Patients should be seen by the doctor at 4, 8 and 12 weeks and 3-monthly thereafter if well. If not well, patients would need to be seen more frequently as determined by the treating doctor or nurse. Safety bloods are to be taken as per schedule. CD4 count will be done 6-monthly while patients are on the first line regimen.

Table 14: Time events schedule

Assessment

Week 0
(baseline)

2ndWeek

4thWeek

8thWeek

12thWeek

Every

Every 3

Every 6

Education/therapeutic counsellor visit

N, C

 

N, C

N, C

N, C

N, C

N, C

 

Treatment readiness assessment

Whole team

             

History

D

             

Physical exam

D

 

D

D

D

N

N

N

Weight

N

 

N

N

N

   

N

Complete registers

N,C

       

N, C

N, C

N, C

Safety blood tests (regimen I and II with NVPa)

N

Na

Na

Na

     

Na

Safety blood tests (regimen II and IV with AZTa)

N

 

N

N

Nb

   

Nb

CD4 count

N

           

N

Adverse events

 

N, P

D, P

D, P

D, P

N, P

   

Adherence checkc

N, C

P, N, C

P, N, C, D

P, N, C, D.

P, N, C, D.

P, N, C, D

   

a. For patients on NVP containing regimens (I and II) ALT will be taken at baseline, week 2, 4 and 8 then 6 monthly. Additional safety bloods will be required in pregnancy.

b. For patients on regimen II and IV i.e., AZT containing, FBC will be done monthly for 3 months, then 6 monthly. Fasting cholesterol, triglycerides and fasting glucose will be done as in table 3.2.

c. Calculate monthly adherence = (tablets dispensed - tablets returned)/(tablets prescribed), e.g. (30 - 5)/28 = 25/28 = 0.9 (90%).

Key: C=counsellor, D=doctor, N=nurse, P=pharmacist


Table 15: Summary of Adult ART Laboratory monitoring of patients on first line regimen

Regimens

Monitoring Tests

Frequency

Rationale

I. d4T/3TC/NVP

• CD4

Staging, 6-monthly

ART monitoring

 

• ALT

Baseline, week 2, 4 and 8, thereafter 6 monthly

Contains NVP

II. AZT/3TC/NVP

• CD4

Staging, 6-monthly

ART monitoring

 

• ALT

Baseline, week 2, 4 and 8, thereafter 6 monthly and whenever symptomatic

Contains NVP and AZT

 

• FBP

Baseline, week 4 and 8, thereafter, 6 monthly

Contains AZT

III. d4T/3TC/EFV

• CD4

Staging, 6-monthly

ART monitoring

 

• ALT

6-monthly or Symptomatic

Contains EFV

IV. AZT/3TC/EFV

• CD4

Staging, 6-monthly

ART monitoring

 

• ALT

6-monthly or Symptomatic

Contains AZT

 

• FBP

Baseline, week 4 and 8, thereafter, 6 monthly

Contains EFV

Staging = initial testing for all patients when being referred for antiretroviral therapy
Baseline = testing for ART eligible patients, at initiation of ART

ii. Unscheduled visits


Beyond the scheduled visits, it is also important for the patients to be counselled to present themselves to the CTC should they develop any unexpected symptoms and complications. Clinical judgement will be used to assess whether additional clinical or laboratory interventions are required.

Immune Reconstitution Syndrome

Patients with advanced HIV disease, particularly those with a CD4 count of less than 50 cells/mm³ may become ill with an immune reconstitution illness during the first few weeks of antiretroviral therapy with symptoms of fever, sweats, loss of weight, cough etc., Tuberculosis is a common immune reconstitution illness.

Immune reconstitution illnesses occur when improving immune function unmasks a previously occult opportunistic infection (an infection that was present in the patient’s body, but was not clinically evident). It is not indicative of drug failure or drug side effects, thus is not a reason to stop ART, or change the regimen.

Opportunistic infections may present in atypical ways during this phase of immune reconstitution. Patients therefore need to be referred to the CTC of the district, regional or referral hospital for advice regarding investigation and management.

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