• 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
    • 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. 

    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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