Presented by Phillip Gachina

ART Transition Updates

 Introduction

• Antiretroviral therapy (ART) is the use of HIV

medicines to treat HIV infection in PLHIV. It is
recommended that treatment with ART should start
as soon as possible to help reduce the risk of
transmission.
• Potential risks of ART include unwanted side effects
from HIV medicines and drug interactions.
• Poor adherence can lead to drug resistance and
treatment failure.
 Protease Inhibitor (PI)
Protease inhibitors (PIs) block protease (an HIV
enzyme). By blocking protease enzyme the PIs
prevent new (immature) HIV virus from becoming a
mature virus that can infect other CD4 cells.
Examples include; Atazanavir (ATV) Darunavir (DRV)
Fosamprenavir (FPV) Indinavir (IDV) Lopinavir
+Ritonavir(LPV/r) Nelfinavir ( NFV) Ritonavir (RTV)
Saquinavir (SQV )Tipranavir (TPV).
Cont..
 CCR5 Antagonist

CCR5 antagonists block the CCR5 co receptor on the

surface of certain immune cells, such as CD4 T
lymphocytes (CD4 cells). This prevents HIV from
entering inside a healthy CD4 cell. It blocks a specific
kind of "hook" (CCR5) on the outside of normal cells
so the virus can't plug in. Examples include
Maraviroc (MVC)
Cont..
 Fusion Inhibitor
A fusion inhibitor blocks the HIV envelope
from merging with the host CD4 cell
membrane (fusion). This prevents HIV from
entering the CD4 cell. Unlike NRTIs, NNRTIs,
and PIs which work on infected cells these
drugs help block HIV from getting inside
healthy cells in the first place. Enfuvirtide
(ENF)
Cont..
Integrase Strand Transfer Inhibitors
(INSTIs)
Integrase strand transfer inhibitors (INSTIs)
block integrase (an HIV enzyme). HIV uses
integrase to insert (integrate) its viral DNA into
the DNA of the host CD4 cell. Blocking
integrase prevents HIV from replicating.
Examples include; Bictegravir (BIC)
Dolutegravir(DTG) Elvitegravir (EVG)
Raltegravir (RAL)
Cont..
 Nucleoside Reverse Transcriptase
Inhibitor (NRTI)
Nucleoside reverse transcriptase inhibitors (NRTIs)
block reverse transcriptase (an HIV enzyme). The HIV
virus uses reverse transcriptase to convert its RNA
into DNA (reverse transcription). Blocking reverse
transcriptase and reverse transcription prevents HIV
from replicating. Examples include; ABC Abacavir
(ABC) Didanosine (DDI) Emitricitabine (FTC)
Lamivudine (3TC) Stavudine (D4T) Tenofovir (TDF)
Zidovudine (AZT).
Cont..
Cont..
Non-Nucleoside Reverse Transcriptase
Inhibitor (NNRTI)
Non-nucleoside reverse transcriptase inhibitors
(NNRTIs) bind to and block HIV reverse transcriptase
(an HIV enzyme). HIV virus uses reverse transcriptase
to convert its RNA into DNA (reverse transcription).
Blocking reverse transcriptase and reverse
transcription prevents HIV from replicating. Examples
include; DLV Delavirdine (DLV) Efavirenz, (EFV)
Etravirine (ETR) NVP Nevirapine (NVP) Rilpivirine
(RPV)
Cont..
 Recommended Regimens for Adults

First-line ART
• TDF (or ABC) + 3TC + EFV (or NVP)
• AZT + 3TC + EFV (or NVP)
• TDF (or ABC or AZT) + 3TC + ATV/r (or LPV/r)

Transition
• DTG + 3TC + EFV
 Recommended Regimens for Adults

Second-Line ART
• AZT + 3TC + ATV/r
• TDF + 3TC + ATV/r
• DRT-based 2nd line
 Recommended Regimens for Adults

Third-Line ART
• DTG(or RAL) + 3TC + DRV + RTV
• DTG(or RAL) + 3TC + DRV + RTV + AZT
• DTG(or RAL) + 3TC + DRV + RTV + 3TC
 Transition
The MOH sent a circular that we're transiting all our
patients on 1st line T.L.E.
(Tenofovir/Lamivudine/Efavirenz) to T.L.D (
Tenofovir/Lamivudine/ Dolutegravir) starting July
2018.

This applies for both New patients and existing

patients except for women between (15yrs to 49
yrs)
 WHY DTG?

• High genetic barrier

• Rapid viral suppression within a short time
• Few side effects / reduced toxicity
• Few interactions with other drugs
 Process of Transition
• All P.L.W.H. except for the women in reproductive age
• HIV Viral load to be done before transiting the
patients.
• Issue one month re-fill of T.L.E. pending the V.L.
results.
• If patient has achieved viral suppression (less than
1000 copies) they are eligible for transition.
• If patient has not achieved viral suppression don’t
transit as you investigate the cause.
 Documentation

• Limited Data exist on DTG hence the need to

document every A.E.
• Need to verify that indeed its achieving fast viral
suppression in African race
• Commodity management
 ART Documentation

• Demonstration of files
• Documentation process
• P.E.P.
• Introduction of Self testing Kits
 Other Information

• IPT use
• Dual testing
Cont..