Modern ART for South Africa

This section explains the basics of starting your treatment, including things like adherence, CD4 count and viral load.

• Does ART really work?

  Yes!

  It will keep you healthy.

  Your life expectancy will be similar to before you were living with HIV.

  It also reduces risk to your partners.

  About 5.9 million people are on ART in South Africa.

  ART works for any age or gender. It works for adults, adolescents, children and babies.

  Taking ART exactly as prescribed reduces HIV in your body to tiny amounts (called “undetectable”).

  Even though you will still be living with HIV, you can expect a long and healthy life.

• Do all people living with HIV need ART?

  Yes.

  South African guidelines recommend ART for everyone living with HIV, whatever their CD4 count or viral load.

  This is the same across the world.

  The treatment works and is easy to take.

  ART usually means taking only one pill a day.

  If you are not on ART, the virus can damage your health even when you feel well.

• Art Combination for 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.

  Before 2020, the combination was based on a drug called efavirenz.

• What is dolutegravir?

  dol-you-TEG-rah-veer

  Dolutegravir is a type of ARV called an integrase inhibitor.

• Why is dolutegravir better than efavirenz?

  Dolutegravir has fewer side effects than efavirenz – so it is even easier for people to take, and for treatment to be effective.

  It is harder to develop resistance to dolutegravir than to efavirenz. The new combination of ARVs also comes in a smaller pill.

• What are the side effects of dolutegravir?

  These are not common, but can include mood changes and difficulty sleeping.

  Occasionally people might need to change to another ARV.

  Some people find it better to take dolutegravir in the morning than the evening.

  Some people gain weight on dolutegravir. South African guidelines encourage everyone to eat a healthy diet and exercise.

• Dolutegravir and TB medicine

  Rifampicin, one of the medicines used in first-line TB treatment, can reduce the levels of other medicines, including dolutegravir.

  This “interaction” between dolutegravir and rifampicin is overcome by adding an extra dolutegravir pill.

  So dolutegravir is taken twice daily (once within TLD and once as a single dose).

  See our booklet ART & TB

• Other medicines and supplements

  There are interactions between dolutegravir and some supplements, heartburn medicine, laxatives and multivitamins, including calcium supplements.

  To overcome this, dolutegravir should be taken two hours before or six hours after these medicines.

  Another important interaction is that dolutegravir doubles levels of metformin (to treat type 2 diabetes) and requires careful monitoring.

• Imbiza

  Less well understood are interactions with traditional herbal medicines or imbiza.

  Traditional medicines are not tested or approved. We do not know what imbiza can do.

  They might weaken the effect of ARVs.

  Using them together might make the ARVs or imbiza more toxic.

  Do not take imbiza with ARVs.

• Adherence

  Adherence means taking your ARVs correctly, as prescribed.

  Adherence is the most important thing you must get right when you start ART.

  Getting into a routine and taking your ART at the same time each day makes it easier. Try using our app or set a reminder on your phone.

• Tests to monitor your health

  CD4 COUNT

  Your CD4 count tells you about your immune system.

  The CD4 range for HIV-negative adults is between 400 and 1600. Above 500 is considered normal.

  Even with a very low CD4 count, ART can help your immune system recover.

  VIRAL LOAD (VL)

  This test shows how much virus is in a sample of blood.

  On ART, viral load should be less than 50 copies/mL.

  This is called “undetectable” (or “suppressed”) and it makes HIV impossible to transmit.

  Everyone with HIV needs to take ART, no matter what their CD4 or viral load is.

• Art and pregnancy

  All HIV-positive pregnant and breastfeeding women should be started on lifelong ART, ideally the same day that pregnancy is confirmed.

  We have also produced a booklet on taking ARVs for women who are or want to become pregnant.

• Keep going!

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