Guidelines for HIV and AIDS Treatment: National Health Department Recommendations
Access detailed evidence and recommendations from the National Essential Medicines List Committee regarding HIV and AIDS treatment guidelines, including eligibility for antiretroviral therapy and preventive therapy. Learn about the management of HIV infection in adults and children, as well as treatment options for HIV exposure in infants.
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Chapter 11: HIV and AIDS NATIONAL DEPARTMENT OF HEALTH AFFORDABLE MEDICINES ESSENTIAL MEDICINES PROGRAMME PRIMARY HEALTHCARE GUIDELINES 2018 1
EVIDENCE Please access the National Essential Medicines List Committee (NEMLC) report for detailed evidence (including rationale, references and costings) informing decision-making on medicine addition, amendments and deletions: http://www.health.gov.za/index.php/standard-treatment-guidelines-and- essential-medicines-list/category/285-phc DISCLAIMER This slide set is an implementation tool and should be used alongside the most recently published STG available on the EML Clinical Guide Application. This information does not supersede or replace the STG itself. 2
HIV infection in adults DESCRIPTION Eligibility and timing for ART CHANGES All HIV positive patients are eligible for ART, irrespective of CD4 count or WHO stage. ART may be started on the same day if the patient has no clinical contraindication, and patient is willing to start. Delay initiation in patients with cryptococcal meningitis or TB meningitis REASON RCTs and observational data show benefit of ART irrespective of CD4 count Increased risk of death with immediate ART initiation in patients with cryptococcal/ TB meningitis 3
HIV infection in adults DESCRIPTION Isoniazid Preventive Therapy (IPT) CHANGES Once active TB has been excluded, duration of IPT amended to 12 months for ALL. Except pregnant women: o If CD4 100cells/microl: IPT deferred until after delivery o If CD4 < 100 cells/microl: active TB excluded with symptom screen, then give IPT REASON IPT for 12 months in patients initiating ART, without the need for a TST is based on data from a randomised controlled trial Evidence of adverse fetal outcomes with intrapartum INH exposure from a RCT. 4
HIV infection in children DESCRIPTION Management of HIV Infected Children CHANGES Children are eligible for ART if there is a confirmed diagnosis of HIV infection, irrespective of CD4 count and WHO clinical stage. REASON Amended to align with Universal Test and Treat Approach 5
