This document provides guidance on changing or stopping antiretroviral therapy (ART) in a rational manner. It describes the main reasons for altering a patient's ART regimen as drug toxicity, interactions, or treatment failure. It discusses how to diagnose and manage common adverse drug reactions and interactions. It emphasizes the importance of assessing adherence before changing a patient's failing regimen and consulting national treatment guidelines and experts when making decisions about second-line therapy.
The extent of inhibition of mitochondrial DNA polymerase gamma is as follows d4T>Zalcitabine (ddC) > Didanosine ( ddI) > Lamivudine (3TC) > Zidovudine (ZDV) > Abacavir (ABC). Generally adverse events are less common in children compared to adults Hyperbilirubinemia, haematuria and nephrolithiasis with Indivanir is more pronounced in children There is high risk of hepatoxicity with ZDV in children below 5 years. Asymptomatic retinal pigmentation with ddI is more likely in children. Be on the look out for diarrhea with NFV and manage the same. The most common adverse events are graded ( see attached table) with suggestions of interventions at each level of grading.
* In NNRTI containing regimens stopping all 3 drugs at once may allow for development of drug resistance. It is therefore recommended that the NRTI backbone should be continued for 2 weeks if possible to reduce the likelihood of NNRTI resistance developing. See Guidelines to ARV Treatment Minimizing Adverse Events Appropriate drug and regimen selection Dose titration Monitoring and reassuring for effects that are transient Appropriate timing of administration Pharmacological interventions Withdrawal of the offending drug(s)
Grade 2 rash (maculopapular dry rash over >50%) body surface
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