INTRODUCTION OF TENOFOVIR 300MG/LAMIVUDINE 300MG/DOLUTEGRAVIR 50MG (TLD) AS A PREFERRED FIRST-LINE ANTIRETROVIRAL MEDICINE FOR TREATMENT OF HIV IN UGANDA.
The Ministry of Health has updated the Consolidated Guidelines for the Prevention and Treatment of HIV and AIDS in Uganda. In the updated guidelines, Tenofovir 300mg/Lamivudine 300mg/ Dolutegravir 50mg (TLD) is the Preferred First-Line Antiretroviral medicine for treatment of adults and adolescents. This is because of the rising levels of pretreatment drug resistance amongst other reasons.
After considering the recent WHO and FDA safety alert of the neural tube defects reported in a study in Botswana, the Ministry of Health has made the following recommendations;
- TLD is the preferred first line medicine for treatment of HIV in Uganda.
- The following categories of HIV positive patients will be initiated on TLD:
- All men > 12 years
- Women > 50 years
- Women of reproductive age (15 to 49 years) on long term contraceptives.
- Women of reproductive age (between 15 to 49 years) will be initiated on Tenofovir300mg/Lamivudine 300mg/Efavirenz 600 mg (TLE or any other ARV regimens other than TLD)
- Children and adolescents < 12 years will be initiated on ABC based regimens
- The substitution of existing patients on other regimens to DTG-based regimen will be guided by points 2, 3 and 4 above.
Patients on stable first regimen should also fulfill the following conditions before substitution
- Have a Viral Load (VL) done in the last six months
- Latest VL should be suppressed as measured by either;
- Less than 200c/ml on plasma samples OR
- Less than 1000c/ml on DBS samples
- Not be on concurrent anticonvulsants including carbamazepine, phenytoin, phenobarbital.
The table below summarizes the recommended treatment substitution options:
** ABC should be maintained for patients with prior history of renal impairment
|Current First line Regimen||Recommended substitution to optimal regimen|
|ABC/3TC/EFV*||TDF/3TC/DTG or TLD|
|ABC/3TC/AZT*||TDF/3TC/DTG or TLD|