HIV Treatment in South Africa
The recomended ART combination is: tenofovir, lamivudine & dolutegravir.
This combination is also called TLD.
Most people living with HIV will be given TLD.
People 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”
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 50 mg 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.
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