RECOMMENDED FIRST LINE IN ADULTS, ADOLESCENTS, PREGNANT WOMEN AND CHILDREN

ART regimens in children are age and weight dependent.
When children grow, doses and regimens have to be changed according to guidelines below.
E.g. a child started at age 2 on ABC+3TC+LPV/r will transition to ABC+3TC+EFV when age >3 and weight >15 kg..

PATIENT
CATEGORY		 INDICATION ARV REGIMEN
Adults and
adolescents
aged 10 years
and older
(>35 kg)		 Recommended
1st Line Regimen

  • Adults and
    adolescents
    initiating ART
 TDF+3TC+EFV1
If EFV is
contraindicated		 TDF+3TC+ NVP
(2014 guidelines)
TDF+3TC+DTG
(2016 guidelines)
If TDF is
contraindicated		 AZT+ 3TC+ EFV
AZT + 3TC + NVP
(2014 guidelines)
ABC+3TC+DTG
(2016 guidelines)
Pregnant and
breastfeeding
women		 Recommended
1st Line Regimen

  • Pregnant OR
    breastfeeding
    women initiating
    ART
 TDF+3TC+EFV1
If TDF3 and/
or EFV2
contraindicated		 ABC + 3TC + ATV/r
Children aged
3 to less than
10 years old
or <35kg		 Recommended
1st Line Regimen

  • Children 3-< 10
    years initiating
    ART
 ABC+3TC+EFV
If EFV is
contraindicated		 ABC + 3TC+NVP
(2014 and 2016
guidelines)
Children <3
years of age
or <15 kg
Recommended
1st Line Regimen

  • Children <3 years
    initiating ART
 ABC+3TC+LPV/r
Syrup or Pellets4
(2014 and 2016
guidelines)
. If unable to use
LPV/r		 ABC + 3TC + NVP
(2014 and 2016
guidelines)

Notes

  1. TDF/3TC/EFV has low toxicity, once daily administration, and is effective against hepatitis B. It is a relatively inexpensive regimen and does not cause
    anaemia as AZT (which can then be reserved for second line). EFV has less risk of treatment failure than NVP.
  2. Contraindications for EFV:
    • Severe clinical depression or psychosis
    • Patient receiving Benzodiazepines or Carbamazepine
    • Ongoing complications of neurological disease that block ability to assess side effects of EFV
    • Age < 3 yrs or weight < 15 kg
  3. Contraindications for TDF
    • Renal disease and/or GFR < 60
    • Adolescents below 35 kg
  4. Children unable to swallow pellets can start on nevirapine and then be switched to LPV/r when able to swallow

Triple NRTI regimens are now discouraged due to high virological failure rates and decrease of patient’s future ART options

Important drug interactions

  • Oral contraceptives: EFV/NVP increase their metabolism causing possible increased risk of contraceptive failure. Use additional barrier method
  • Injectable progesteron-only contraceptives and IUDs: there is no significant interaction with ARVs and can be used effectively
  • Levonorgestrel implants: effect reduced by EFV and NVP, use additional barrier method
  • For emergency contraception: double the dose
  • Rifampicin: increase metabolism of PI/nevirapine. See TB-HIV section.