New HIV treatment
South Africa is changing to a new first-line HIV antiretroviral treatment (ART).
The new ART combination will be: tenofovir, lamivudine and dolutegravir. This combination is also called TLD.
Most people living with HIV will be given TLD.
Some people, including some who are treated for tuberculosis (TB), will be given efavirenz-based ART.
For more information about TLD, read the “Starting ART” section.
How do I find out if I have TB?
Everyone starting ART will be tested for TB.
What if I don't have active TB?
If you are tested and don’t have active TB*, you will be started on TB preventive therapy (TPT).
TB preventive therapy is done with a drug called isoniazid (INH), taken once a day for 12 months.
You will also be given pyridoxine (vitamin B6) to help prevent peripheral neuropathy (nerve damage)
TPT and ART will help to stop you getting TB.
* Active TB means that you have TB with symptoms.
Symptoms of active TB
Symptoms of active TB could include:
- Coughing that lasts three or more weeks
- Coughing up blood
- Chest pain, or pain with breathing or coughing
- Weight loss
- Extreme tiredness
- Night Sweats
What if I do have TB?
If you test positive for active TB and it is drug sensitive* you will start treatment with Rifafour.
This treatment is a combination of four anti-TB drugs: rifampicin, isoniazid, pyrazinamide and ethambutol.
*Drug sensitive means that the TB is not resistant to first-line TB drugs.
TB treatment & CD4 count
You will start ART soon after starting TB treatment, depending on your CD4 count:
- If your CD4 is less than 50 cells/mm3 – start ART within two weeks of starting TB treatment, when your symptoms are improving, and TB treatment is tolerated.
- If your CD4 is more than 50 cells/mm3 – start ART eight weeks after starting TB treatment.
What ART combination will I start with?
If you are not already on ART when you start your TB treatment you will be given a combination based on efavirenz.
This is because rifampicin lowers the dose of dolutegravir. This is called a drug-drug interaction.
How long do I need to stay on efavirenz?
The efavirenz-based ART should be continued until two weeks after TB treatment is finished.
After this the efavirenz can be switched to dolutegravir.
What if I am already on ART when I find out I have TB?
If you are on efavirenz-based ART you will continue this until you finish your TB treatment.
If you are on dolutegravir-based ART you will need a double dose of dolutegravir to overcome the interaction with rifampicin.
If you are on TLD FDC, you will need to add a dolutegravir 50mg dose 12 hours after taking TLD. So if you take your TLD in the morning, you will need to take your extra dolutegravir in the evening.