National ART Guidelines 2023

Question 1

TLD 1 vs TLD 2

Answer 1

TLD 1 = DTG regimen who have never failed any other regimen
TLD 2 = DTG regimen who have failed an earlier regimen

Question 2

What is the new TDF weight eligibility?

Answer 2

30kg

Question 3

What is the dose of DTG dispersible tablets?

Answer 3

10mg

Question 4

When is AZT reserved for use?

Answer 4

Renal failure AND hypersensitivity

Question 5

What is the definition of virological failure?

Answer 5

> 2 VLs >1000 >2 years of DTG/PI containing regimen with >80% adherence

Question 6

When can DTG-containing regimen be changed?

Answer 6

Must be confirmed with a resistance test

Question 7

What is the preferred 1st line regimen in adults?

Answer 7

TLD

Question 8

What is the preferred 1st line regimen in children?

Answer 8

ALD

Question 9

When should ART be initiated in a patient with CD4< 50 and DS-TB at a non-neurological site?

Answer 9

Within 2 weeks

Question 10

When should ART be initiated in a patient with CD4>50 and DS-TB at a non-neurological site?

Answer 10

Within 8 weeks

Question 11

When should ART be initiated in a pregnant patient with DS-TB at a non-neurological site?

Answer 11

Within 2 weeks

Question 12

When should ART be initiated in a patient with DR-TB at a non-neurological site?

Answer 12

Within 2 weeks

Question 13

When should ART be initiated in a patient with TB at a neurological site?

Answer 13

4-8w after TB treatment initiation

Question 14

When should ART be initiated in a patient with positive serum CrAg but negative CSF CrAg without symptoms?

Answer 14

Immediately

Question 15

When should ART be initiated in a patient with cryptococcal meningitis?

Answer 15

4-6w after antifungal treatment initiation

Question 16

When should ART be initiated in a patient with PCP or bacterial pneumonia?

Answer 16

Within 1-2 weeks

Question 17

When should ART be initiated in a patient with clinical symptoms/sign of liver disease?

Answer 17

Investigate first

Question 18

How do we test for TB in an HIV positive patient at initiation?

Answer 18

Symptom screen
GXP

Question 19

When should a U-LAM be done?

Answer 19

Any hospitalised HIV patient
OR
Outpatient with CD4 < 200, AHD or current serious illness

Question 20

What are the baseline tests at ART intiation?

Answer 20

CD4
Renal function (TDF)
Hb (AZT)
GXP
Cervical cancer screening HBsAg

Question 21

How should eGFR be calculated in adults >16yo

Answer 21

MDRD equation

Question 22

What are indications for CPT in a HIV positive child <1yo?

Answer 22

All children regardless of CD4 or clinical stage

Question 23

What are indications for CPT in a HIV positive child 1-5yo?

Answer 23

CD4% <25%
WHO stage 2, 3, 4

Question 24

What are indications for CPT in a HIV positive child <5yo with PJP infection?

Answer 24

Start CPT after PJP treatment is complete

Question 25

What are indications for CPT in a HIV positive child >5yo

Answer 25

CD4 <200 WHO stage 2, 3, 4

Question 26

When can CTP be stopped in a HIV positive child 1-5yo?

Answer 26

CD4 >25% regardless of clinical stage

Question 27

When can CTP be stopped in an HIV positive child >5yo?

Answer 27

CD4>200 regardless of clinical stage

Question 28

When can CTP be stopped in a HIV positive child <5yo with PJP infection?

Answer 28

Continue until 5yo and then stop once CD4>200

Question 29

What is the criteria for TPT in adults >15yo?

Answer 29

Exclude active liver disease, alcohol abuse or INH sensitivity Any CD4

Question 30

What is the dose for TPT in adults >15yo?

Answer 30

INH 300mg po dy x 12 months + pyridoxine 25mg dy

Question 31

What is the criteria for TPT in children with HIV <15yo

Answer 31

HIV child with positive TB contact

Question 32

What is the criteria for TPT in children <5yo?

Answer 32

ANY child with positive TB contact

Question 33

What is the dose for TPT in children <15yo?

Answer 33

INH 10mg/kg/d for 6 months (max 300mg)

Question 34

What is the criteria for TPT in pregnant women?

Answer 34

Exclude active liver disease, alcohol abuse or INH sensitivity Any CD4

Question 35

What is 50mg of film coated DTG tablet equivalent to in dispersible DTG tablets?

Answer 35

30mg

Question 36

When should antacids be taken in relation to TLD?

Answer 36

2 hours AFTER 6 hours BEFORE

Question 37

Which anticonvulsants are contraindicated with DTG?

Answer 37

Carbamazepine Phenobarbital Phenytoin

Question 38

Which anticonvulsants are not contraindicated with DTG?

Answer 38

Valproate (C/I in pregnancy) Lamotrigine Levetiracetam Topiramate

Question 39

If alternative anticonvulsant cannot be used, how do you proceed with DTG-regimen?

Answer 39

Double DTG dose to 50mg bd

Question 40

What is first line ART for neonates 2-3kg and <4 weeks old?

Answer 40

AZT + 3TC + NVP

Question 41

What is first line ART for infants >3kg and >4 weeks old?

Answer 41

ALD

Question 42

What is first line ART for children >30kg and >10yo?

Answer 42

TLD

Question 43

How do you initiate ART in an adult diagnosed during labour?

Answer 43

Stat dose TLD and stat dose NVP

Question 44

How do you re-initiate ART in a non-pregnant client with interrupted treatment?

Answer 44

<28d missed - continue routine care and routine VL monitoring >28d missed - assess clinically Clinically well, missed appointment <90d - continue ART Clinically well, missed appointment >90d - Restart ART and do CD4 Clinically unwell - Restart ART and do CD4 For all above, repeat VL after 3 months

Question 45

How long should ART boosting regimen continue after stopping rifampicin?

Answer 45

2 weeks

Question 46

Which ARVs interact with TB treatment?

Answer 46

DTG NVP LPV/r Atazanavir Darunavir

Question 47

How do you adjust LPV/r in TB treatment?

Answer 47

a) double dose 800/200 bd OR b) superboost 400/100 bd PLUS 300mg ritonavir bd

Question 48

Can you double dose LPV/r syrup?

Answer 48

NO! Only tablets Superboosting can be done with tablets and syrup

Question 49

At what age and weight can EFV be used?

Answer 49

>10kg and >3yo

Question 50

Can you crush LPV or ritonavir tablets?

Answer 50

NO!

Question 51

What is the criteria for a switch from a LPV/r or ATV/r regimen to a DTG-regimen to be non VL-dependent?

Answer 51

Must have been on the regimen <2y

Question 52

What is the criteria for switching to a DTG-regimen from a LPV/ATV/r regimen with >2 VL >1000 2 years after starting the regimen?

Answer 52

Adults: Adherence <80% - do not do resistance test, same day switch Adherence >80% - do resistance test, do not same-day switch OR Children Adherence <80% with solution/pellets - change to 4 in 1 capsules to improve adherence and repeat VL in 3 months Adherence <80% with tablets - change to ALD Adherence >80% - discuss with HIV expert and do resistance test

Question 53

How can you measure good adherence?

Answer 53

1. Pharmacy refills >80% in last 6-12 months 2. Attendance >80% in last 6-12 months 3. ARV detection in blood or urine

Question 54

If you change from an NNRTI based regimen to an InSTI-based regimen in adults do you need to do resistance testing?

Answer 54

No

Question 55

If you change from an InSTI based regimen to an PI-based regimen in adults do you need to do resistance testing?

Answer 55

Yes

Question 56

What is the visit schedule for all patients >5yo on ART?

Answer 56

Initiation - baseline eGFR, CD4 Month 1 - review results Month 3 - VL, eGFR Month 4 - review results Month 7 - collect medicine Month 10 - VL, eGFR, CD4 Month 11 - review then begin annual monitoring

Question 57

When do you repeat CD4?

Answer 57

1. Every 6 months until CD4 >200 2. Every 6 months until VL<1000 3. New WHO stage 3/4 condition 4. Treatment interruption >90d

Question 58

When do you check for dyslipidemia on a PI-based regimen?

Answer 58

Month 3

Question 59

When do you repeat FBC on an AZT-based regimen?

Answer 59

Month 1, month 3 and if clinically indicated

Question 60

What is the schedule for TB screen at follow up visits?

Answer 60

At every f/u, symptom screen Every 12 months, GXP Hospitalisation, U-LAM Outpatient CD4<200, AHD or serious illness, U-LAM

Question 61

How often should VL be monitored in BF women?

Answer 61

Every 6 months from start of breastfeeding

Question 62

What are the ABCDEs of elevated VL?

Answer 62

Adherence Bugs Correct dose Drug interactions REsistance

Question 63

What do you do for a patient on TLD1 with confirmed virological failure?

Answer 63

Repeat VL in 6 months

Question 64

When do you do resistance testing in TLD confirmed virological failure?

Answer 64

Patients on TLD2 - discuss with HIV expert

Question 65

Which special circumstances warrant a resistance test on TLD1?

Answer 65

Perinatally affected adolescents Existence of drug interactions

Question 66

When do you repeat TB smear?

Answer 66

Week 7 Week 23

Question 67

What is the ART regimen in neonates 2kg >35w GA?

Answer 67

AZT + 3TC + NVP

Question 68

What is the ART regimen in infants >3kg and >4w?

Answer 68

ABC + 3TC + DTG