Clinical conditions indicating that a change to second-line therapy is warranted include:
Lack of growth response or decline in growth over a 6-months period, after excluding other causes, including TB.
Not meeting neurodevelopmental milestones
Development of HIV encephalopathy in a child with no previous manifestations
Recurrence of infections, such as oral candidiasis, that are refractory to treatment
Advancement from one clinical stage to another or new evidence of stage 3 disease
Note: Short intercurrent episodes of pneumonia, LRTI and gastroenteritis should not be regarded as clinical failure. TB can present as a progression to stage 3 disease and must first be excluded.