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Assosa university


Health science collage
Department of nursing

by: Birhnu A

4/17/2019 by: Birhanu A 1


When to start ART in adults and adolescents

 Early treatment initiation is associated
with clinical and HIV prevention
benefits, improving survival and reducing
the incidence of HIV infection at the
family and community level.

4/17/2019 by: Birhanu A 2


Con …

Start ART as early as possible to all adults and
adolescents with a confirmed HIV diagnosis who
are ready & willing regardless of their WHO
clinical stages and CD4 counts.
As the level of maturity varies, some younger
adolescents may need parental consent and
support. Prenatally infected adolescents need
special consideration.
4/17/2019 by: Birhanu A 3
When to start ART in pregnant and breast feeding

women
Start ART as early as possible to all
pregnant & breastfeeding women living
with HIV regardless of their WHO
clinical stages and CD4 counts.

4/17/2019 by: Birhanu A 4


For a women identified at labor & delivery,
provide ART the same hour with brief
counseling and provide detailed counseling
on ARVs & adherence
after delivery.
Consequently, provide prophylaxis for the
infant for 6 to 12 weeks based on the
duration of maternal ART coverage (Refer
to HEI section)
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When to start ART in children

 Start ART as early as possible to all children living with
HIV regardless of their WHO clinical
stages and CD4 counts/ percentage.
 Infants and young children infected with HIV have
exceptionally higher morbidity & mortality. Up to 52% and
75% of children die before the age of two and five years
respectively in the absence of any intervention.
 For HIV infected infants diagnosed with the first DNA
PCR result, Initiate ART and take DBS
specimen for confirmatory DNA PCR.

4/17/2019 by: Birhanu A 6


Continue ART, if the second DNA PCR
confirms whereas if the second DNA PCR

turns negative, without holding the ART
make the 3rd DNA PCR test.

For HIV infected Infants and younger
children who need particular care &
support from parents and care givers,
ensure the readiness and understanding of
their parents and care givers.
HIV infected infants shall be started on
ART and counseling on dosage and
administration will be provided for parents.
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First line ART for adults and adolescents


A once daily fixed dose combination of TDF +
3TC + EFV is recommended as first-line ART in
Adults and Adolescents.
The already available TDF-3TC-EFV (FDC)
contains 600mg of EFV but TDF – 3TC – EFV
(FDC) with 400mg of EFV preparation has been
recently approved to be used as first line
regimen and
4/17/2019 by: Birhanu A 8
this will replace the already available TDF-3TC-

EFV with 600mg EFV preparation soon up on
availability.
In older patients with long-term diabetes,
uncontrolled hypertension and renal failure,
select appropriate drug from the alternative
regimen.
In patients with depression with suicidal
ideation and previous history of acute psychosis,
use alternative regimen and avoid EFV.
4/17/2019 by: Birhanu A 9
First-line ART for pregnant and breastfeeding
women and ARV prophylaxis for their infants
 
A once-daily fixed-dose combination of TDF + 3TC + EFV is
recommended as first-line ART in
pregnant and breastfeeding women, including pregnant
women in the first trimester of pregnancy
and women of childbearing age.
 The infant prophylaxis duration bases on the total duration of
maternal ART usage.

4/17/2019 by: Birhanu A 10


 For infants born to HIV infected women who took ART for


more than 4 weeks at time of delivery, give NVP prophylaxis
for 6 weeks.
 For infants born to mothers covered with ART for less than 4
weeks or for who is diagnosed at birth or postpartum, give
extended NVP prophylaxis for the infant for 12 weeks.
 Infant prophylaxis should begin within 1 hour at birth or when
HIV exposure is recognized
postpartum.

4/17/2019 by: Birhanu A 11


Duration
Maternal Infant
of infant
Scenario
ARV
 ARV
prophylaxi prophylaxi
ARV
prophylaxi
sa sb
s
6 weeks,
Mother59
extend to
diagnosed Initiate 12
with maternal NVP weeks if
HIV during ART mother took
pregnancy ART for <4
c,d
4/17/2019 by: Birhanu A
weeks 12

Mother diagnosed
with
HIV during labor or Initiate
immediately maternal NVP 12 weeks
postpartum and plans ART
to
breastfeed

4/17/2019 by: Birhanu A 13


Mother diagnosed
with


HIV during labour
Refer mother for
or
HIV care and
immediately NVP 12 weeks
evaluation
postpartum
for treatment
and plans
replacement
feeding

Infant identified as
HIV
12 weeks, Plus
exposed after birth
Take DBS specimen
(through infant or
Initiate maternal for DNS PCR for
maternal NVP
ART. EID
HIV antibody
same day if infant
testing)
older than 4weeks.
and
is on breastfeeding
4/17/2019 by: Birhanu A 14
Infant identified as
HIV
Take DBS, do
exposed after birth


Refer mother for DNA
(through infant or
HIV care and No ARV PCR test, initiate
maternal
evaluation prophylaxis treatment if the
HIV antibody
for treatment infant
testing)
is infected
and is
not breastfeeding

Mother receiving
Determine an
ART
alternative ART
but interrupts ART Until 6 weeks
regimen or
regimen while after maternal
solution;
breastfeeding ART is restarted or
counsel NVP
(such as until 1-week after
regarding
toxicity, stock-outs breastfeeding has
continuing ART
or ended
without
refusal to
4/17/2019
interruption by: Birhanu A 15
continue)