Southern African HIV Clinicians Society guidelines for antiretroviral therapy in adults: 2020 update

Jeremy Nel¹, Sipho Dlamini², Graeme Meintjes³, Rosie Burton⁴, John M Black⁵, Natasha E C G Davies⁶, Eric Hefer⁷, Gary Maartens⁸, Phetho M Mangena^{9

10}, Moeketsi T Mathe¹¹, Mahomed-Yunus Moosa¹², Muhangwi B Mulaudzi¹³, Michelle Moorhouse¹⁴, Jennifer Nash¹⁵, Thandeka C Nkonyane^{16

17}, Wolfgang Preiser^{18

19}, Mohammed S Rassool²⁰, David Stead^{21

22}, Helen van der Plas², Cloete van Vuuren^{23

24}, Willem D F Venter²⁵, Joana F Woods²⁵

Affiliations

¹ Helen Joseph Hospital, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa.
² Department of Infectious Diseases, Faculty of Medicine, University of Cape Town, Cape Town, South Africa.
³ Department of Medicine, Division of Infectious Diseases and HIV Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
⁴ Southern African Medical Unit, Médecins Sans Frontières (MSF), Cape Town, South Africa.
⁵ Department of Medicine, Division of Infectious Diseases, Livingstone Tertiary Hospital, Port Elizabeth, South Africa.
⁶ Anova Health Institute, Johannesburg ,South Africa.
⁷ Private Practice Medical Adviser, Johannesburg, South Africa.
⁸ Department of Medicine, Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa.
⁹ Department of Internal Medicine, School of Medicine, Pietersburg Hospital, Polokwane, South Africa.
¹⁰ Department of Medicine, School of Medicine, University of Limpopo, Turfloop, South Africa.
¹¹ Private Practice, Vereeniging, South Africa.
¹² Department of Infectious Diseases, Division of Internal Medicine, University of KwaZulu-Natal, Durban, South Africa.
¹³ Private Practice (Phomolong Medical Centre), Rustenburg, South Africa.
¹⁴ Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
¹⁵ Specialist Family Physician, Amathole District Clinical Specialist Team, East London, South Africa.
¹⁶ Department of Infectious Diseases, Faculty of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
¹⁷ Department of Medicine, Dr George Mokhari Hospital, Pretoria, South Africa.
¹⁸ Department of Medical Virology, National Health Laboratory Service, Tygerberg, South Africa.
¹⁹ Department of Pathology, Faculty of Medicine and Health, Stellenbosch University, Cape Town, South Africa.
²⁰ Clinical HIV Research Unit, Wits Health Consortium, Johannesburg, South Africa.
²¹ Department of Medicine, Faculty of Infectious Diseases, Frere and Cecilia Makiwane Hospitals, East London, South Africa.
²² Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa.
²³ Department of Internal Medicine, Military Hospital, Bloemfontein, South Africa.
²⁴ Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
²⁵ Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

PMID: 33101723
PMCID: PMC7564911
DOI: 10.4102/sajhivmed.v21i1.1115

Southern African HIV Clinicians Society guidelines for antiretroviral therapy in adults: 2020 update

Jeremy Nel et al. South Afr J HIV Med. 2020.

. 2020 Sep 16;21(1):1115.

doi: 10.4102/sajhivmed.v21i1.1115. eCollection 2020.

Authors

Affiliations

¹ Helen Joseph Hospital, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa.
² Department of Infectious Diseases, Faculty of Medicine, University of Cape Town, Cape Town, South Africa.
³ Department of Medicine, Division of Infectious Diseases and HIV Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
⁴ Southern African Medical Unit, Médecins Sans Frontières (MSF), Cape Town, South Africa.
⁵ Department of Medicine, Division of Infectious Diseases, Livingstone Tertiary Hospital, Port Elizabeth, South Africa.
⁶ Anova Health Institute, Johannesburg ,South Africa.
⁷ Private Practice Medical Adviser, Johannesburg, South Africa.
⁸ Department of Medicine, Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa.
⁹ Department of Internal Medicine, School of Medicine, Pietersburg Hospital, Polokwane, South Africa.
¹⁰ Department of Medicine, School of Medicine, University of Limpopo, Turfloop, South Africa.
¹¹ Private Practice, Vereeniging, South Africa.
¹² Department of Infectious Diseases, Division of Internal Medicine, University of KwaZulu-Natal, Durban, South Africa.
¹³ Private Practice (Phomolong Medical Centre), Rustenburg, South Africa.
¹⁴ Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
¹⁵ Specialist Family Physician, Amathole District Clinical Specialist Team, East London, South Africa.
¹⁶ Department of Infectious Diseases, Faculty of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
¹⁷ Department of Medicine, Dr George Mokhari Hospital, Pretoria, South Africa.
¹⁸ Department of Medical Virology, National Health Laboratory Service, Tygerberg, South Africa.
¹⁹ Department of Pathology, Faculty of Medicine and Health, Stellenbosch University, Cape Town, South Africa.
²⁰ Clinical HIV Research Unit, Wits Health Consortium, Johannesburg, South Africa.
²¹ Department of Medicine, Faculty of Infectious Diseases, Frere and Cecilia Makiwane Hospitals, East London, South Africa.
²² Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa.
²³ Department of Internal Medicine, Military Hospital, Bloemfontein, South Africa.
²⁴ Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
²⁵ Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

PMID: 33101723
PMCID: PMC7564911
DOI: 10.4102/sajhivmed.v21i1.1115

No abstract available

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

**FIGURE 1**
Timing of viral load monitoring of the patient starting antiretroviral therapy. For patients with a viral load > 50 copies/mL on two consecutive occasions, refer to the text.

**FIGURE 2**
Suggested approach to patients with low cluster of differentiation 4 counts despite a suppressed viral load on antiretroviral therapy.

**FIGURE 3**
Switching from a first-line non-nucleoside reverse transcriptase inhibitor-based regimen to a dolutegravir-based regimen.

**FIGURE 4**
Virological monitoring of patients receiving dolutegravir-based first-line antiretroviral therapy and response to results.

**FIGURE 5**
Indications for performing resistance (genotype) testing in second-line antiretroviral therapy.

See this image and copyright information in PMC

References

1. Johnson LF, Mossong J, Dorrington RE, et al. . Life expectancies of South African adults starting antiretroviral treatment: Collaborative analysis of cohort studies. PLoS Med. 2013;10(4):e1001418 10.1371/journal.pmed.1001418 - DOI - PMC - PubMed
1. Maartens G. ‘Covering the tail’ after stopping efavirenz-based antiretroviral therapy. S Afr J HIV Med. 2020;21(1):a1036 10.4102/sajhivmed.v21i1.1036 - DOI - PMC - PubMed
1. Benhamou Y, Bochet M, Thibault V, et al. . Long-term incidence of hepatitis B virus resistance to lamivudine in human immunodeficiency virus-infected patients. Hepatology. 1999;30(5):1302–1306. 10.1002/hep.510300525 - DOI - PubMed
1. Fernandez-Fernandez B, Montoya-Ferrer A, Sanz AB, et al. . Tenofovir nephrotoxicity: 2011 update. AIDS Res Treat. 2011;2011:354908 10.1155/2011/354908 - DOI - PMC - PubMed
1. Venter WDF, Fabian J, Feldman C. An overview of tenofovir and renal disease for the HIV-treating clinician. South Afr J HIV Med. 2018;19(1):817 10.4102/sajhivmed.v19i1.817 - DOI - PMC - PubMed

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Southern African HIV Clinicians Society guidelines for antiretroviral therapy in adults: 2020 update

Affiliations

Southern African HIV Clinicians Society guidelines for antiretroviral therapy in adults: 2020 update

Authors

Affiliations

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources