Department of Health HIV-treatment-guidelines.pdf

HIV Treatment Guidelines of Opportunistic Infections

1. HIV
TREATMENT
GUIDELINES
FOR HIV PRACTITIONERS



AIDS RESEARCH GROUP
RESEARCH INSTITUTE FOR TROPICAL MEDICINE
DEPARTMENT OF HEALTH

2. PROPHYLAXIS & TREATMENT MEDICATIONS USED FOR HIV PATIENTS
MEDICATION DOSAGE WHEN TO GIVE WHEN TO STOP ALTERNATIVES

ISONIAZID (INH) 300 MG
treatment and prevention of TB


1 tab OD on an empty stomach,
30 minutes before breakfast or
2 hours after meals
*given with Pyridoxine 25mg OD

Asymptomatic
Normal chest x-ray
Post TB treatment (secondary)

6 months post-initiation
Active hepatitis b infection
Elevated SGPT and/or SGOT
Hypersensitivity reactions

None



COTRIMOXAZOLE 800MG/160MG










Primary prophylaxis
1 tab OD with food


Treatment of PCP:
2 tabs TID for 21 days
(15-20mg/kg/day and 75mg/kg/day)

Adjunctive Corticosteroids
20mg/tab 2 tabs BID (80mg/day) for 1-5 days
20mg/tab 1 tab BID (40mg/day) for 6-10 days
taper until reaching 5mg/day

CD4 less than 350
WHO stage 3 & 4
Active TB regardless of CD4 count

TB patients



PaO2 less than 70mmHg @ room air
Alveolar-Arterial 02 gradient
greater than 35mmHg


Clinically stable on ART with evidence of immune
recovery and viral suppression


Hypersensitivity reactions






Dapsone 100mg OD
without G6PD deficiency










AZITHROMYCIN 500MG


2 1/2 tabs once a week
1 hour before or 2 hours after meals


not on fully suppressive ART
and CD4 <50

initiation of effective ART and CD4 >100 for more
than 3 months


Clarithromycin 500mg BID



FLUCONAZOLE 200MG

1 tab OD for 7 days
before or after meals

Oral Candidiasis

after 7 days


ITRACONAZOLE 100 CAP BID

COTRIMOXAZOLE
RE-CHALLENGE
PHASE DURATION GANCICLOVIR VALGANCICLOVIR
CMV RETINITIS TREATMENT

Induction

14-21 days

5mg/kg every 12 hours

2 tabs BID

Chronic maintenance

6 months

5mg/kg/day OD

2 tabs OD
PHASE DURATION MEDICATIONS
CRYPTOCOCCAL MENINGITIS TREATMENT

Induction

2 weeks

Amphotericin B Deoxycholate 1mg/kg IV once daily + Fluconazole 800 mg PO/IV one daily

Consolidation

8 weeks

Fluconazole 400mg PO or IV once daily

Suppressive maintenance

at least 12 months

Fluconazole 200mg PO once daily
SYRUP 200/40 MG
Day 1 1 ml OD
Day 2 2.5 ml OD
Day 3 5 ml OD
TABLET 400/80 MG
Day 4 1/2 tab OD
Day 2 1 tab OD
TABLET 800/160 MG
Day 6 1/2 tab OD
Day 7 1 tab OD
Onwards 1 tab OD
AIDS RESEARCH GROUP
RESEARCH INSTITUTE FOR TROPICAL MEDICINE
DEPARTMENT OF HEALTH

TB Preventive Therapy
Cotrimoxazole Preventive Therapy
Mycobacterium Avium Complex Prophylaxis

3. (Nucleoside Reverse Transcriptase Inhibitors)
NRTI
ANTIRETROVIRAL MEDICATIONS AVAILABLE FOR HIV PATIENTS
(Non-Nucleoside Reverse Transcriptase Inhibitors) (Protease Inhibitors) (Integrase Inhibitors)

LAMIVUDINE (3TC)
ABACAVIR (ABC)
ZIDOVUDINE (AZT)
TENOFOVIR (TDF)
AIDS RESEARCH GROUP
RESEARCH INSTITUTE FOR TROPICAL MEDICINE
DEPARTMENT OF HEALTH

NNRTI PI INSTI / INI

NEVIRAPINE (NVP)
EFAVIRENZ (EFV)
RILPIVIRINE (RPV)


LOPINAVIR boosted RITONAVIR (LPV/r)


DOLUTEGRAVIR (DTG)

FIRST LINE
TREATMENT LINE
2 NRTI + 1 INSTI
3TC/TDF/DTG
LAMIVUDINE 300mg/TENOFOVIR 300mg/DOLUTEGRAVIR 50mg
1 tab OD fixed dose combination
Preferred first-line treatment for treatment-naive, newly diagnosed, and
returning to care
DRUGS OF CHOICE GENERIC AND DOSAGE REMARKS
2020 ANTIRETROVIRAL THERAPY GUIDELINES
First line alternative
2 NRTI + 1 NNRTI
3TC/TDF/EFV
LAMIVUDINE 300mg/TENOFOVIR 300mg/EFAVIRENZ 600mg
1 tab OD fixed dose combination
For patients diagnosed with TB, taking Rifampicin
First line alternative
2 NRTI + 1 NNRTI
3TC+ABC+EFV
LAMIVUDINE 150mg 1 tab BID + ABACAVIR 300mg 1 tab BID +
EFAVIRENZ 600mg 1 tab OD
For patients with renal insufficiency, liver problem, and estimated
creatinine clearance of <60ml/minute
First line alternative
2 NRTI + 1 NNRTI
3TC/TDF+RPV
LAMIVUDINE 300mg/TENOFOVIR 300mg 1 tab OD +
RILPIVIRINE 25mg 1 tab OD
For patients who cannot tolerate the side effects of Efavirenz
(neuropsychiatric side effects, like, drowsiness,
dizziness and nightmares and high cholesterol)
Note: CANNOT BE GIVEN WITH RIFAMPICIN
SECOND LINE
2 NRTI + 1 PI
3TC/AZT+LPV/r
LAMIVUDINE 150mg/ZIDOVUDINE 300mg 1 tab BID +
LOPINAVIR 200mg boosted RITONAVIR 50mg 2 tabs BID
Preferred second-line treatment
(dependent on genotyping results)
Second line alternative
2 NRTI + 1 INSTI
3TC/TDF/DTG
TLD is easy to take and DTG may be potent enough that even if there is
some resistance to TDF and/or 3TC it should still suppress the virus
Patients switching to TLD for second-line ART should have a VL test to
ensure viral suppression 3-6 months after switch
LAMIVUDINE 300mg/TENOFOVIR 300mg/DOLUTEGRAVIR 50mg
1 tab OD fixed dose combination
OTHER IMPORTANT GUIDELINES:
start ARVs within 2 weeks of TB treatment; TB meningitis: 4-8 weeks(+) tuberculosis
start ARVs 14-21 days after induction of Valganciclovir / Ganciclovir(+) CMV retinitis
start ARVs 4-6 weeks after initiation of cryptococcal treatment(+) cryptococcal meningitis
Reference: World Health Organization. (2021). Consolidated guidelines on HIV prevention, testing, treatment, service delivery, and monitoring: recommendations from a public health approach. https://www.who.int/publications/i/item/9789240031593

4. CBC
CD4
Chest X-ray
HBsAg
RPR/VDRL
Urinalysis
Fecalysis
Pregnancy Test (when applicable)
Optional
Lipid profile
Creatinine
SGPT / SGOT
Serum CALAS (for those with complaints of
headache, fever, and CD4 less than 100)
Pap Smear (for women of reproductive age)
RECOMMENDED VACCINATIONS
Dose / Route:
Schedule of immunization:
Indications:
Adverse reaction:
40 ug intramuscular
Day 0, 1 month, and 6 months
Alternative regimen:
Day 0, 1 month, 2 months, and 12 months
If given with Hepatitis A, give doses at day 0, 1 month, and 6 months
No past or previous HepB infection
IDU, MSM, multiple sexual partners, household or close contacts, HCW, travelers to
areas of high prevalence
Transient soreness, erythema, and induration at injection site
HEPATITIS B VACCINE
Dose / Route:
Schedule of immunization:
Indications:
Adverse reaction:
0.5 ml single dose, IM or SC
Annually
Elderly, those with underlying chronic conditions, immunodeficiency
Soreness at injection site, fever, malaise, myalgia, arthralgia, allergic reaction
INACTIVATED INFLUENZA VACCINE
Dose / Route:
Schedule of immunization:
Indications:
Adverse reaction:
0.5 ml of PPSV23 or PCV13, but PCV13 is strongly recommended, IM or SC into the
deltoid
If PCV13 is given first, give PPSV23 after 2 months. Revaccination of PPSV23 every 5
years may be considered
If PPSV23 is given first, give PCV13 at least after 1 year. Revaccination of PPSV23
every 5 years may be considered
> 65 years, asplenia, immunosuppression, solid organ or bone marrow transplant,
chronic disease
Soreness, swelling, and redness at the injection site; resolves within 48 hours
PNEUMOCOCCAL VACCINE
09690395403 (GLOBE)
09617488594 (GLOBE)
09154128364 (GLOBE)
09665373794 (GLOBE)
09208787253 (SMART)
09497098730 (SMART)
Monday - Friday 8 AM - 4:30 PM, except holidays
09176456199 (GLOBE)
09471417895 (SMART)
Monday - Friday 8 AM - 5 PM, except holidays
09568253842 (GLOBE)
09760588356 (GLOBE)
Monday - Friday 9 AM - 12 NN, except holidays
09760588356 (GLOBE)
Monday - Friday 9 AM - 12 NN, except holidays
09172400615 (GLOBE)
88072631/32/37 LOCAL 262
Go to: http://bit.ly/ritmonlinedocumentrequest
Monday - Friday 8 AM - 4 PM, except holidays
88072631/32/37 LOCAL 332
[email protected]
Monday - Friday 8 AM - 5 PM, except holidays
REGISTRATION FOR NEXT DAY APPOINTMENT
Go to: http://bit.ly/argteleconsult
Monday - Friday 8 AM - 2 PM or until all slots are booked
TELECONSULTATION HOTLINE
09770278114 (GLOBE)
[email protected]
Monday - Friday 8 AM - 5 PM, except holidays
ARG TELECONSULT
VL/CD4/ANNIVERSARY
ARV REFILL / COUNSELING
COVID-19 VACCINE CLEARANCE
TRANSFER-IN /
NEW PATIENT ENROLLMENT
ANNUAL LAB RESULTS
MEDICAL RECORDS / HIMD
Ophthalmology
Fundoscopy (CD4 less than 100)
BASELINE LABORATORIES: CBC, CD4, HBsAg, RPR Qualitative, Chest X-ray
ANNIVERSARY LABORATORIES:
3TC/TDF/EFV: CBC, Creatinine, Lipid Profile, HIV-1 VL, CXR
3TC/AZT/NVP: CBC, HIV-1 VL, CXR
BASIC LABORATORIES: