Guidelines to Antiretroviral Drug Therapy in Kenya: FOREWORD

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	Guidelines to Antiretroviral Drug Therapy in Kenya (WHO; 2001; 78 pages)
		FOREWORD
		ACKNOWLEDGMENT
		CHAPTER ONE: INITIATING ANTIRETROVIRAL THERAPY
			1.1 Introduction
			1.2 Guidelines to making a diagnosis of HIV infection
			1.3 Laboratory Diagnosis of HIV infection
			1.4 Goals of therapy
			1.5 When to start therapy
			1.6 Risks and benefits of delayed initiation of therapy and of early therapy in the Asymptomatic HIV-Infected Patient
			1.7 Antiretroviral profile
			1.8 What drug combination to start with?
		CHAPTER TWO: MONITORING AND CHANGING THERAPY
			2.1 Surrogate markers
			2.2 Resistance testing
			2.3 How often should CD4 Cell Count and Viral Load be performed (Frequency)
			2.4 Treatment failure
			2.5 Reasons for non-adherence
			2.6 Considerations for changing a failing regimen
			2.7 Guidelines for changing an antiretroviral regimen for suspected drug failure
			2.8 Potential options for changing therapy*
		CHAPTER THREE: PHARMACOTHERAPEUTICS OF ARVS
			3.1 Characteristics of available antiretroviral drugs
			3.2 Pharmacokinetic properties of Antiretrovirals
		CHAPTER FOUR: GUIDELINES FOR THE USE OF ANTIRETROVIRAL DRUGS IN PAEDIATRIC HIV INFECTION
			4.1 Overview
			4.2 Diagnosis of HIV infection in children
			4.3 When to initiate treatment
			4.4 Initiation of treatment
			4.5 Agents to choose for initial treatment
			4.6 Dosages for paediatric formulations
			4.8 Monitoring
			4.9 When to change therapy
		CHAPTER FIVE: MANAGEMENT OF HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTED PREGNANT WOMEN AND PREVENTION OF MOTHER TO CHILD TRANSMISSION (MTCT) OF HIV
			5.1 Overview
			5.2 Factors affecting mother to child transmission
			5.3 Outline antenatal, intrapartum postpartum and postnatal care
			5.4 Antiretroviral Therapy to prevent MTCT
		CHAPTER SIX: SPECIAL CONSIDERATIONS
			6.1 Acute retroviral syndrome (ARVS)
			6.2 ARV drugs and the treatment of Tuberculosis
			6.3 Immune recovery syndrome
		CHAPTER SEVEN: WHEN TO STOP TREATMENT (INTERRUPTIONS)
			7.1 Structured treatment interruptions (STI's)
			7.2 Non structured treatment interruption
		CHAPTER EIGHT: GUIDELINES FOR POST EXPOSURE PROPHYLAXIS
			8.1 Treatment of exposure sites
			8.2 Timing of post - HIV exposure prophylaxis initiation
			8.3 Assessment of exposure risk
			8.4 Post - HIV exposure prophylaxis
			8.5 Recommended HIV serology after exposure
			8.6 Management of health care workers with accidental exposure to HIV infection
			8.7 Management of hospital staff with sharp injury or exposure to blood and body fluids
			8.8 Management of non occupational exposure to HIV infection
			8.9 Management of non-sexual and non occupational Exposures to HIV
		CHAPTER NINE: ACCESS TO DRUGS IN KENYA
		APPENDICES
			I. Drug to drug interactions
			II. Drug to drug interactions (continued)
			III. Drug Interactions Between Antiretrovirals and Other Drugs
			IV. Nucleoside Reverse Transcriptase Inhibitors (NRTIS)
			V. Drug Interactions: Protease Inhibitors
			VI. Drug Interactions: Protease Inhibitors and Non-Nucleoside Reverse Transcriptase Inhibitors - Cont.
			VII. Drug That Should Not be Used With Antiretrovirals
			VIII. Drugs that should not be used with Protease Inhibitors Antiretrovirals
			IX. HIV-related drugs with overlapping toxicities
			X. Anti-retroviral therapy for preventing MTCT
		BACK COVER

FOREWORD

Acquired Immune Deficiency Syndrome (AIDS) is a rapidly growing public health problem in Kenya. In less than a decade, AIDS has evolved from a fulminant, rapidly fatal illness into a chronic disease. Already more than 2 million are estimated to have been infected in Kenya as from 1985 when the first case of AIDS was recognized.

The Guidelines are meant for the use of trained clinicians who have primary responsibility for treatment of HIV/AIDS patients.

The mainstay of managing HIV/AIDS epidemic is prevention and advocacy for behaviour change. However, Kenya hospitals continue to offer care to many patients who occupy beds for long with recurrent complications. Currently drugs for opportunistic infections are provided in public hospitals including anti-TB drugs. With advancing technology new powerful antiretroviral drugs regimens have become available and now form part of total continuum care of HIV/AIDS patients.

Proper use of these drugs, and monitoring will require capacity building of staff hence need for standard treatment protocols for providing the highest quality and most cost-effective health care. With the publication of these Guidelines to antiretroviral drug therapy, the Ministry is establishing standard regimens for antiviral drug use and monitoring of patients.

The manual is the result of considerable collective effort of senior clinicians and pharmacists from the Ministry of Health, the University of Nairobi and private hospitals.

It is hoped that these stakeholders will participate in training of doctors and nurses in rural hospitals where many AIDS patients are hospitalized. Availability of retroviral drugs to Kenyans who need them is the subject of debate but no doubt the government will soon put in place legal framework to increase access to these drugs.

These drugs will be used along-side priority advocacy for behaviour change at all levels in Kenya. The approach adopted by Kenya in the fight of Aids revolves around the sessional paper No. 4 of 1997 and the National Aids Control Strategy.

Like most publications, the initial edition requires regular revisions and updates in terms of content and context.

DR. RICHARD O. MUGA, OGW, DSM,
DIRECTOR OF MEDICAL SERVICES

FEBRUARY, 2002

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