Modern ART for South Africa

Manage HIV and TB together by learning about symptoms, preventive therapy, and how TB affects your ART medication.

• HIV Treatment in South Africa

  ART is usually three ARVs in one pill – called a fixed-dose combination.

  Since 2020 the recommended combination is tenofovir, lamivudine and dolutegravir. This combination is 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.

• How do I find out if I have TB?

  Everyone starting ART will be tested for TB.

  For more information about TLD please read our booklet “Starting ART”

• 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
  • Fever
  • Night sweats
  • Chills

• 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, not dolutegravir.

  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.

• 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).

  TPT is managed 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).

  There are also newer options such as 3HP, made up of isoniazid and a drug called rifapentine and taken once a week for 3 months.

  TPT and ART will help to stop you getting TB. A course of TPT may be given more than once to people living with HIV. It should also be given to people who are in contact with people with TB, including adolescents and children, as well as those at high risk of getting TB.

  *Active TB means that you have TB with symptoms.

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