Summary table of HIV treatment regimens

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  • Infants and children (#)
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# regimens found that match the criteria
Regimen Summary Table
 Regimen Acronyms
Country Clients/Year Issued Criteria For Starting
ARV Treatment 		First Line
Regimen 		Second Line
Regimen 		Third Line
Regimen
Argentina Adults and adolescents
2009

All patients with:

  • CD4 count < 350/mm3; or
  • A history of AIDS-defining illness or clinically significant symptoms suggesting advanced disease.

If CD4 count is > 350/mm3 but < 500/mm3, patient should be considered for ART if:

  • Viral load > 100,000 copies/mL;
  • There is a drop in CD4 count of > 100/mm3 per year; or
  • Patient has co-morbidities including cardiovascular, renal, or hepatic illness and non-AIDS related cancers

 

The choice of first line regimen should be individualized based on potential advantages and disadvantages specific to each patient. Refer to the guidelines for further guidance (pg. 7-18).

The choice of second line regimen should be individualized based on potential advantages and disadvantages specific to each patient. Refer to the guidelines for further guidance (pg. 65-73).

______
Argentina Infants and children
2009

All children < 2 years of age

Children 2 to 5 years of age with:

  • AIDS-defining illness or clinically significant symptoms (CDC Category B or C);
  • CD4% < 25%; or
  • CD4% > 25% but viral load > 100,000 copies/mL

Children > 5 years of age* with:

  • AIDS-defining illness;
  • Clinically significant symptoms (CDC Category B or C); or
  • CD4 < 350/mm3

*Consider starting treatment when child is asymptomatic or has mild clinical symptoms.

PI-based regimens:

2 NRTIs
+
LPV/r

Alternative:

< 6 years of age:

2 NRTIs
+
NFV

> 6 years of age:

2 NRTIs
+
FPV/r or ATV/r

---------------------

NNRTI-based regimens:

Children < 3 years of age:

2 NRTIs
+
NVP

Children > 3 years of age:

2 NRTIs
+
EFV

Alternative :

2 NRTIs
+
NVP

For treatment failure with PI regimens:

2 new NRTIs
+
PI/r or NNRTI
+
NNRTI

---------------------

For treatment failure with NNRTI regimens:

2 new NRTIs|
+
PI/r (or NNRTI)

______
Bhutan Infants and children
2008

Children < 18 months of age with:

  • CD4% < 25% (1500/mm3);
  • TLC < 3400/mm3; or
  • WHO pediatric clinical stage 3 or 4

Children 18 months to 5 years of age with:

  • CD4% < 15% (500/mm3);
  • TLC < 2300/mm3; or
  • WHO pediatric clinical stage 3 or 4

Children > 5 years or age with:

  • CD4% < 15% (200/mm3);
  • TLC < 1200/mm3; or
  • WHO pediatric clinical stage 3 or 4

AZT
+
3TC
+
EFV or NVP

d4T
+
3TC
+
EFV or NVP

______
Bolivia Adults and adolescents
2009

All patients with:

  • WHO clinical stage 1, 2 or 3 with CD4 count < 500/mm3; or
  • WHO clinical stage 4

AZT or d4T*
+
3TC
+
NVP or EFV

*Limit the use only in the case of AZT toxicity

---------------------

AZT
+
3TC
+
ddI

3TC or AZT
+
ddI
+
IDV/r or LPV/r

---------------------

TDF
+
3TC
+
IDV/r or LPV/r

______
Botswana Adults and adolescents
2008

All patients with:

  • CD4 count < 250/mm3; or
  • WHO clinical stage 3 or 4

TDF
+
FTC or 3TC
+
EFV or NVP

AZT
+
3TC
+
LPV/r

DRV/r
+
RAL
Botswana Infants and children
2008

All infants (< 12 months of age)

Children < 5 years of age:

Based on age-related
CD4% according to WHO

Children > 5 years of age with:

WHO pediatric clinical stage 3 or 4

d4T or AZT
+
3TC
+
NVP or EFV or LPV/r

ABC
+
d4T
+
LPV/r

______
Brazil Adults and adolescents
2008

All patients with:

  • CD4 count < 200/mm3;
  • A history of AIDS-defining illness or clinically significant symptoms suggesting advanced disease; or
  • CD4 count > 200/mm3 and < 350/mm3 with viral load >100,000 copies/mL

AZT
+
3T
+
EFV or LPV/r

ddI or TDF
+
3TC
+
NVP or ATV/r

______
Cambodia Adults and adolescents
2007

Patients must fulfill psychosocial criteria to initiate ART.

All patients with:

  • CD4 count < 250/mm3; or
  • WHO clinical stage 4 (defer ART if patient is co-infected with extra-pulmonary TB and CD4 count > 250/mm3)

d4T
+
3TC
+
NVP

For alternative first-line regimens for special cases, refer to Table 4 on page 12 of the guidelines.

TDF
+
3TC
+
LPV/r

---------------------

ddI
+
3TC
+
LPV/r

_______
Chile Adults and adolescents
2005

All patients with:

  • CD4 count < 200/mm3; or
  • A history of CDC Category C illness, with the exception of pulmonary TB

All patients with CD4 count > 200/mm3 and < 250/mm3
with one or more of the following:

  • CDC Category B illness;
  • CD4 decrease of 20/mm3 per month; or
  • Viral load of >100,000 copies/mL

AZT or ddI
+
3TC
+
EFV or NVP

---------------------

AZT or ddI
+
3TC
+
LPV/r

ABC
+
3TC
+
EFV or NVP

---------------------

ABC
+
3TC
+
LPV/r

---------------------

ABC or AZT
+
3TC
+
ATV/r

______
Chile Infants and children
2005

Infants < 3 months of age with:

  • Confirmed HIV infection, except CDC Category N or A with high CD4 count and low viral load

Infants 3 to 12 months of age with:

  • CDC Category C;
  • WHO pediatric clinical stage 3; or
  • CDC Category B2 if viral load is high and CD4% < 25%

Children 1 to 3 years of age with:

  • CDC Category C;
  • WHO pediatric clinical stage 3; or
  • CDC Category B2 if viral load is high and CD4% < 20%

Children > 3 years with:

  • CDC Category C;
  • WHO pediatric clinical stage 3; or
  • CDC Category B2 if viral load is high and CD4 count is risky

Children < 3 years of age:

AZT or d4T or ABC
+
3TC
+
NVP or NFV or LPV/r

---------------------

AZT
+
ddI
+
NVP or NFV or LPV/r

Children > 3 years of age:

AZT or d4T or ABC
+
3TC
+
EFV or NFV or LPV/r

---------------------

AZT
+
ddI
+
EFV or NFV or LPV/r

______

______
Colombia Adults and adolescents
2005

All patients with:

  • CD4 count < 200/mm3; or
  • HIV-related symptoms

Consider treating patients with:

  • CD4 count < 250/mm3; or
  • CD4 count > 250/mm3 and < 350/mm3
     with a viral load > 100,000 copies/mL

AZT or d4T or ddI or ABC
+
3TC
+
EFV or NVP

---------------------

AZT
+
3TC
+
FPV/r or SQV/r or LPV/r or ATV/r

ABC
+
ddI
+
EFV or NVP

---------------------

ABC
+
ddI
+
FPV/r or SQV/r or LPV/r or ATV/r

---------------------

AZT or d4T
+
ABC
+
FPV/r or SQV/r or LPV/r or ATV/r

---------------------

AZT or d4T
+
ABC
+
EFV or NVP

---------------------

3TC
+
ABC
+
EFV or NVP

---------------------

3TC
+
ABC
+
FPV/r or SQV/r or LPV/r or ATV/r

---------------------

3TC
+
d4T or ddI
+
EFV or NVP
+
LPV/r

______
Côte d Ivoire Adults and adolescents
2005

All patients with:

  • CD4 count < 200/mm3;
  • CD4 count < 350/mm3
    and CDC Category B; or
  • WHO clinical stage 2, 3 or 4
    or CDC Category C

d4T or AZT
+
3TC
+
NVP or EFV

ABC or TDF
+
ddI
+
LPV/r or SQV/r or IDV/r

Refer to specialized
hospital
Côte d Ivoire Infants and children
2005

Children < 18 months of age with:

  • WHO pediatric clinical stage
    3 or CDC Category C irrespective
    of CD4%; or
  • WHO pediatric clinical stage
    1 or 2 with CD4% < 20%

Children > 18 months of age with:

  • CD4% < 15%; or
  • WHO pediatric clinical stage
    3 or CDC Category C

d4T or AZT
+
3TC
+
NVP or EFV

ABC
+
ddI
+
LPV/r

Refer to specialized
hospital
Cuba Adults and adolescents
2009

All patients with CD4 count < 350/mm3

Patients with special conditions, including:

  • Viral load > 55,000 copies/mL
  • Co-morbidities such as Hepatitis B or C,
    cirrhosis of the liver, or cancer
  • Age > 55 years

AZT or d4T
+
3TC or ddI
+
NVP or IDV

Refer to the guidelines for further guidance (pg. 18).

______
Democratic Republic of Congo Adults and adolescents
2005

All patients with:

  • CD4 count < 200/mm3;
  • WHO clinical stage 4; or
  • CD4 count < 350/mm3
    at WHO clinical stage 3

d4T or AZT
+
3TC
+
NVP or EFV

ABC
+
ddI
+
LPV/r

______
Democratic Republic of Congo Infants and children
2005

Children < 18 months of age with:

  • WHO pediatric clinical
    stage 3 irrespective
    of CD4%; or
  • WHO pediatric clinical
    stage 1 or 2 with CD4%
    < 20%

Children > 18 months of age with:

  • WHO pediatric clinical
    stage 3 irrespective
    of CD4%; or
  • WHO pediatric clinical
    stage 1 or 2 with CD4%
    < 15%

Children < 3 years of age:

AZT
+
3TC
+
NVP

Children > 3 years of age:

d4T
+
3TC
+
NVP

ABC
+
ddI
+
NFV

______
Djibouti Adults and adolescents
2008

All patients with:

  • CD4 count < 350/mm3; or
  • WHO clinical stage 4; or
  • WHO clinical stage 3 when CD4 testing is not available

AZT
+
3TC
+
EFV or NVP

---------------------

d4T
+
3TC
+
EFV

 

Alternative:

AZT
+
3TC
+
ABC

---------------------

AZT or d4T
+
3TC
+
LPV/r or NFV or SQV/r

ddI or TDF
+
ABC
+
LPV/r or NFV or SQV/r

---------------------

TDF
+
3TC (± AZT)
+
LPV/r or NFV or SQV/r

---------------------

EFV or NVP ± ddI
+
LPV/r or NFV or SQV/r

______
Dominican Republic Adults and adolescents
2004

All patients with:

  • CD4 count < 200/mm3 and WHO clinical stage
    1, 2 or 3;
  • WHO clinical stage 4;
  • Rapid CD4 decline (>20/mm3/month)
    and viral load > 100,000 copies/mL; or
  • WHO clinical stage 2 or 3 and TLC < 1200/mm3

AZT
+
3TC
+
EFV or NVP

AZT
+
3TC
+
IDV/r

Use of four or more ARVs. See guidelines for further guidance (pg. 64-67).
Dominican Republic Infants and children
2004

Children < 18 months of age with:

  • WHO pediatric clinical stage 3; or
  • WHO pediatric clinical stage 1
    or 2 and CD4% < 20%

Children > 18 months and < 13 years of age with:

  • WHO pediatric clinical stage 3; or
  • WHO pediatric clinical stage 1
    or 2 and CD4 % < 15%

Children weighing < 10 kg:

AZT
+
3TC
+
NVP

Children weighing > 10 kg:

AZT
+
3TC
+
EFV

AZT
+
3TC
+
LPV/r

______
Ecuador Adults and adolescents
2007

All patients with:

  • CD4 count < 200/mm3;
  • AIDS-defining illness or CDC Category
    B or C symptoms; or
  • CD4 count > 200/mm3 but < 350/mm3
    with a viral load > 100,000 copies/mL

AZT or ddI or ABC or d4T
+
3TC
+
EFV

---------------------

AZT or d4T
+
3TC
+
NVP

---------------------

AZT
+
3TC
+
SQV/r or LPV/r or ATV/r

---------------------

TDF
+
TC
+
NNRTI or PI

Refer to the guidelines for further guidance (pg. 42-43)

______
El Salvador Adults and adolescents
2005

Evaluate the following:

  1. 1. Presence of symptoms associated with HIV
  2. 2. Diagnostic confirmation with 2 ELISA tests and other confirmatory tests as required by diagnostic algorithm in use
  3. 3. A low CD4 count according to international standards
  4. 4. A high viral load according to international standards
  5. 5. A psychosocial assessment approved by the institutional committee

AZT
+
3TC
+
IDV/r or EFV or NVP

d4T (for those with anemia)
+
3TC
+
IDV/r or EFV or NVP

---------------------

AZT
+
ddI
+
IDV/r or EFV or NVP

______
El Salvador Infants and children
2005

All children should get a psychosocial evaluation approved by the Institutional Committee.

Infants (< 12 months of age) of infected mothers independent of immunological state and viral load, especially those with:

  • Clinical evidence of HIV infection (CDC Category B or C)
  • Clinical evidence of immunosuppression (WHO pediatric clinical stage 2 or 3)
  • Viral load > 300,000 copies/mL

Children 1 to 3 years of age with:

  • Clinical evidence of HIV infection (CDC Category B or C);
  • Clinical evidence of immunosuppression (WHO pediatric clinical stage 2 or 3);
  • Viral load > 100,000 copies/mL; or
  • Drop in a Category based on a decrease in CD4 count or percent within a 3-6 month period

Children 3 to 13 years of age with:

  • Clinical evidence of HIV infection (CDC Category B or C);
  • Clinical evidence of immunosuppression (WHO pediatric clinical stage 2 or 3);
  • Viral load > 20,000 copies/mL; or
  • Drop in a Category based on a decrease in CD4 count or percent within a 3-6 month period

AZT
+
3TC
+
NVP (<3 years of age) or
EFV (> 3 years of age) or
NFV or RTV or LPV/r

---------------------

AZT
+
ddI
+
NVP (<3 years of age) or
EFV (> 3 years of age) or
NFV or RTV or LPV/r

---------------------

d4T
+
ddI
+
NVP (<3 years of age) or
EFV (> 3 years of age) or
NFV or RTV or LPV/r

AZT or d4T
+
ddI or 3TC
+
LPV/r or NFV or RTV or NVP or IDV/r or SQV/r

Patients must visit
a specialized health center.
Ethiopia Adults and adolescents
2008

All patients with:

  • CD4 count < 200/mm3;
  • WHO clinical stage 4; or
  • CD4 count < 350/mm3 at WHO clinical stage 3

 

d4T or AZT
+
3TC
+
NVP or EFV

-----------------------

ABC
+
3TC
+
AZT

ABC
+
3TC
+
LPV/r or ATV/r

---------------------

AZT
+
ABC
+
LPV/r or ATV/r

---------------------

TDF
+
3TC
+
LPV/r or ATV/r

---------------------

ABC
+
ddI
+
LPV/r

---------------------

EFV or NVP
+
LPV/r or ATV/r

______
Ethiopia Infants and children
2008

All infants (< 12 months of age)

Children from 1 to 5 years of age with:

  • WHO pediatric clinical stage 3 or 4; or
  • WHO pediatric clinical stage 1 or 2 at CD4% < 20%

Children >5 years of age with:

  • CD4% < 15%

d4T or AZT
+
3TC
+
NVP or EFV or LPV/r

ABC
+
ddI
+
LPV/r or NFV

______
Ghana Adults and adolescents
2005

All patients with:

  • CD4 count < 250/mm3; or
  • WHO clinical stage 3 or 4

d4T or AZT
+
3TC
+
NVP or EFV

ABC
+
ddI
+
LPV/r or SQV/r or NFV

______
Ghana Infants and children
2005

Children < 18 months of age with:

  • WHO pediatric clinical stage
    3 or 4 irrespective of CD4%; or
  • WHO pediatric clinical stage
    2 with CD4% < 20%

Children > 18 months of age with:

  • WHO pediatric clinical stage
    3 or 4 irrespective of CD4%; or
  • CD4% < 15%

d4T or AZT
+
3TC
+
NVP or EFV

ABC
+
ddI
+
SQV/r or NFV

______
Guatemala Adults and adolescents
2006

Adults:

All patients with:

  • AIDS defining illness;
  • CD4 count < 200/mm3; or
  • WHO clinical stage 3 or 4

Consider treatment if:

  • CD4 count > 200 and < 350/mm3;
  • There is a 30% decline from previous to current CD4 count;
  • Presence of HIV-related symptoms (e.g. weight loss > 10%, diarrhea or fever > one month);
  • WHO clinical stage 2; or
  • TLC < 1250/mm3

Adolescents:

The Tanner scale, which categorizes stages of physical development, is used to determine how treatment should be managed in adolescents. Refer to the guidelines for further guidance (pg. 58-59).

Adults:

d4T
+
3TC
+
NVP or EFV

---------------------

AZT
+
3TC
+
EFV or NVP

Adults:

AZT
+
ddI
+
IDV/r or LPV/r or NFV or SQV/r

---------------------

d4T
+
ddI
+
LPV/r or IDV/r or NFV or SQV/r

---------------------

AZT
+
ddI
+
EFV

---------------------

d4T
+
ddI
+
EFV

Adults:

These must be decided on an individual basis at Tertiary Care Centers.
Guatemala Infants and children
2006

All infants (< 12 months of age) with:

  • CD4% < 20%;
  • CDC Category B or C;
  • WHO pediatric clinical stage 2 or 3; or
  • HIV-related clinical symptoms

Chidren > 12 months of age with:

  • CDC Category B or C or CD4% < 25%; or
  • No clinical symptoms and no immunosuppresion with viral load > 100,000 copies/mL

Infants (<12 months of age):

AZT
+
3TC
+
NFV or NVP or LPV/r

Children > 12 months of age:

(if < 3 years of age and weighing < 10 kg)

AZT
+
3TC
+
NVP or NFV

(if > 3 years of age and weighing > 10 kg)

AZT
+
3TC
+
EFV

d4T
+
ddI
+
LPV/r or NFV

---------------------

ABC
+
ddI
+
LPV/r or NFV

 

If deterioration and disease progression continue or growth delays persist despite adequate nutritional support, the child must be evaluated by a specialist for consideration of another regimen change.
Guyana Adults and adolescents
2006

All patients with:

  • CD4 count < 350/mm3 irrespective
    of WHO or CDC staging; or
  • WHO clinical stage 3 or 4 or CDC stage
    B or C (symptomatic disease) irrespective
    of CD4 count

d4T or AZT
+
3TC
+
NVP or EFV

-------------------

TDF
+
FTC or 3TC
+
NVP

TDF
+
FTC or 3TC
+
LPV/r

----------------

TDF
+
AZT
+
FTC or 3TC
+
LPV/r

______
Guyana Infants and children
2006

Infants < 12 months of age with:

  • WHO pediatric clinical stage
    3 or 4 irrespective of CD4%; or
  • WHO pediatric clinical stage
    1 or 2 with CD4% < 25%

Children from 1 to 5 years of age with:

  • WHO pediatric clinical stage
    3 or 4 irrespective of CD4%; or
  • WHO pediatric clinical stage
    1 or 2 with CD4% < 20%

Children > 5 years of age with:

  • WHO pediatric clinical stage
    3 or 4 irrespective of CD4 count or %; or
  • CD4 count < 350/mm3

AZT
+
3TC
+
NVP or EFV

ABC
+
ddI
+
LPV/r

______
Haiti Adults and adolescents
2008

All patients with:

  • CD4 count < 200/mm3; or
  • WHO clinical stage 3 or 4

Those with a CD4 count > 200/mm3
 but < 350/mm3 may be considered for treatment

TDF
+
FTC
+
EFV or NVP

---------------

AZT or d4T
+
3TC
+
EFV or NVP

AZT
+
3TC
+
LPV/r

---------------

TDF
+
FTC
+
LPV/r

______
India Infants and children
2006

Clinical Markers

Infants < 12 months of age with:

  • WHO pediatric clinical
    stage 3 or 4

Children > 12 months of age with:

  • WHO pediatric clinical
    stage 4; or
  • WHO pediatric clinical
    stage 3, but use CD4
    as a guide for children
    with TB, LIP, OHL or
    thrombocytopenia

Immunological Markers

  • CD4 count <1500/mm3 (25%)

Children 12 to 35 months of age with:

  • CD4 count < 7500/mm3 (20%)

Children 36 to 59 months of age with:

  • CD4 count < 350/mm3 (15%)

Children > 5 years of age with:

  • CD4 count < 200/mm3; or
  • CD4 count < 350/mm3
    at WHO pediatric clinical
    stage 3

d4T or AZT
+
3TC
+
NVP or EFV

ddI
+
ABC or AZT or EFV or NVP
+
LPV/r or SQV/r or NFV

______
India Adults and adolescents
2007

All patients with:

  • CD4 count < 200/mm3; or
  • WHO clinical stage 4

Those with a CD4 count > 200/mm3 but < 350/mm3 at WHO clinical stage 3 may be considered for treatment.

d4T or AZT
+
3TC
+
NVP or EFV

ABC
+
ddI
+
LPV/r or SQV/r or NFV

______
Kenya Adults and adolescents
2005

All patients with:

  • CD4 count < 200/mm3;
  • WHO clinical stage 4; or
  • CD4 count < 350/mm3
     at WHO clinical stage 3

d4T or AZT
+
3TC
+
NVP or EFV

ABC
+
ddI
+
LPV/r or SQV/r or NFV

______
Kenya Infants and children
2005

Children < 18 months of age with:

  • WHO pediatric clinical stage
    3 irrespective of
    CD4%; or
  • WHO pediatric clinical stage
    1 or 2 with CD4% < 20%

Children > 18 months of age with:

  • CD4% < 15%; or
  • WHO pediatric clinical stage 3

Children not exposed previously to NVP for PMTCT

Children < 3 years, weighing < 10 kg:

AZT
+
3TC
+
NVP

Children > 3 years, weighing > 10 kg:

AZT
+
3TC
+
NVP or EFV

---------------------

Children previously exposed to NVP for PMTCT

All ages:

AZT
+
3TC
+
LPV/r

ABC
+
ddI
+
LPV/r

______
Liberia Adults and adolescents
2007

All patients with:

  • CD4 count < 200/mm3; or
  • WHO clinical stage 4; or
  • WHO clinical stage 2 and CD4 count < 200/mm3 or TLC < 1200/mm3; or
  • WHO clinical stage 3 and CD4 count < 350/mm3

AZT
+
3TC
+
NVP or EFV

---------------------

TDF
+
3TC
+
NVP or EFV

---------------------

d4T
+
3TC
+
NVP or EFV

TDF or AZT
+
3TC
+
LPV/r or ATV/r or NFV

---------------------

ABC
+
ddI
+
LPV/r or ATV/r or NFV

_______
Liberia Infants and children
2007

All infants and children with:

  • WHO pediatric clinical stage 3 or 4

Infants < 11 months of age with:

  • CD4% < 25% (CD4 count < 1500/mm3); or
  • WHO pediatric clinical stage 2 and TLC < 4,000/mm3

Children 12 to 35 months of age with:

  • CD4% < 20% (CD4 count < 750/mm3); or
  • WHO pediatric clinical stage 2 and TLC < 3,000/mm3

Children 36 to 59 months of age with:

  • CD4% < 15% (CD4 count < 350/mm3); or
  • WHO pediatric clinical stage 2 and TLC < 2,500/mm3

Children > 5 years of age with:

  • CD4% < 15% (CD4 count < 200/mm3); or
  • WHO pediatric clinical stage 2 and TLC < 2,000/mm3

Children < 3 kg:

AZT
+
3TC
+
NVP

---------------------

Children > 3 kg:

d4T
+
3TC
+
NVP

ABC
+
ddI
+
LPV/r or NFV

______
Malawi Adults and adolescents
2008

All patients with:

  • CD4 count < 250/mm3;
  • WHO clinical 3 or 4; or
  • TLC < 1200/mm3 at WHO clinical stage 3

d4T or AZT
+
3TC
+
NVP or EFV

AZT
+
3TC
+
TDF
+
LPV/r

______
Malawi Infants and children
2008

Children < 18 months of age with:

  • WHO pediatric clinical stage 4; or
  • Two or more of: oral candidiasis,
    severe pneumonia, severe sepsis

Children > 18 months of age with:

  • CD4% < 15%; or
  • WHO pediatric clinical stage 3 or 4

d4T or AZT
+
3TC
+
NVP or EFV

ABC
+
ddI
+
LPV/r

______
Mexico Adults and adolescents
2009

All patients with:

  • CD4 count < 350/mm3; or
  • AIDS-defining illness, severe opportunistic
    infections, chronic active hepatitis B or nephropathy

Treatment is optional for patients with CD4 count
between 350/mm3 and 500/ mm3 with:

  • Viral load > 100,000 copies/mL;
  • Annual CD4 count decline of 50-100/mm3;
  • Patient age > 55 years; or
  • Co-infection with hepatitis C

TDF
+
FTC
+
EFV or ATV/r or FPV/r or LPV/r or SQV/r

---------------------

ABC
+
3TC
+
EFV or ATV/r or FPV/r or LPV/r or SQV/r

AZT or TDF
+
ABC
+
ddI
+
EFV or ATV/r or FPV/r or LPV/r or SQV/r or DRV/r or TPV/r

---------------------

TDF
+
AZT or 3TC or FTC
+
EFV or ATV/r or FPV/r or LPV/r or SQV/r or DRV/r or TPV/r

---------------------

ABC
+
ddI or 3TC or FTC
+
EFV or ATV/r or FPV/r or LPV/r or SQV/r or DRV/r or TPV/r

MVC, RAL, ENF. See guidelines for further guidance (pg. 22-27).
Mexico Infants and children
2009

Infants (< 12 months of age) with:

  • CDC Category A, B or C; or
  • Evidence of immunosuppression

All children from 1 to 13 years of age with:

  • CDC Category C;
  • CDC Category N, A, or B with a single episode of severe bacterial infection or lymphocytic interstitial pneumonitis
  • CDC Category B and viral load > 100,000 copies/mL

Infants (< 1 year of age):

2 NRTIs
+
NFV or LPV/r* or RTV

*Not in infants < 6 months

-----------------------

2 NRTIs
+
NVP

Children from 1 to 13 years of age:

AZT
+
3TC or ddI
+
LPV/r or RTV or NFV

-----------------------

d4T
+
3TC or FTC
+
LPV/r or RTV or NFV

TDF
+
ABC
+
LPV/r or RTV or NFV

-----------------------

ABC or AZT or d4T*
+
3TC or FTC or ddI
+
LPV/r or RTV or NFV

*In case of toxicity to AZT

______
Mozambique Adults and adolescents
2006

All patients with:

  • CD4 count < 200/mm3 at WHO clinical stage 1 or 2
  • CD4 count < 350/mm3 at WHO clinical stage 3; or
  • WHO clinical stage 4

d4T or AZT or ddI
+
3TC
+
NVP

AZT or d4T
+
ddI
+
NFV

______
Namibia Adults and adolescents
2003

All patients with:

  • CD4 count < 200/mm3; or
  • WHO clinical stage 4

d4T or AZT
+
3TC
+
NVP or EFV

d4T or AZT
+
3TC or ddI
+
LPV/r or IDV/r

______
Namibia Infants and children
2003

Children < 8 years of age with:

  • WHO pediatric clinical stage 3
    irrespective of CD4%; or
  • WHO pediatric clinical stage 1
    or 2 with CD4% < 20%

Children > 8 years of age with:

  • CD4 count < 200/mm3

AZT
+
3TC
+
NVP

ddI
+
d4T
+
LPV/r

______
Nepal Adults and adolescents
2003

All patients with:

  • CD4 count < 200/mm3;
  • WHO clinical stage 4; or
  • TLC < 1200/mm3 at WHO clinical stage 2 or 3

AZT
+
3TC
+
EFV or NVP

PI/r (IDV/r, LPV/r, SQV/r)
+
d4T
+
ddI

______
Nepal Infants and children
2003

Children < 18 months of age
With positive virologic test and:

  • CD4% < 20% at WHO pediatric clinical stage 1 or 2; or
  • WHO pediatric clinical stage 3

With no virologic test and:

  • CD4% < 20% at WHO pediatric clinical stage 3

Children ≥ 18 months of age with:

  • CD4% < 15% at WHO pediatric clinical stage 1 or 2; or
  • WHO pediatric clinical stage 3

AZT
+
3TC
+
NVP
(or EFV if child is ≥ 3 years or ≥ 10kg)

---------------------

Preferred if concomitant anti-tuberculosis
therapy is being received:

AZT
+
3TC
+
ABC

d4T
+
ddI
+
LPV/r or NFV

---------------------

d4T
+
ddI
+
LPV/r or NFV or NVP
(or EFV if child is ≥ 3 years or ≥ 10kg)

______
Nicaragua Adults and adolescents
2009

All patients with:

  • CD4 count < 350/mm3;
  • AIDS-defining illness or symptoms of advanced
    disease (CDC Category B or C), hepatitis B or
    HIV-associated nephropathy; or
  • CD4 count >350/mm3 and viral load > 100,000 copies/mL

CD4 count > 200/mm3:

AZT
+
3TC
+
EFV or NVP

---------------------

TDF
+
FTC or 3TC
+
EFV or NVP

CD4 count < 200/mm3:

AZT
+
3TC
+
LPV/r

---------------------

TDF
+
FTC
+
LPV/r

CD4 count > 200/mm3:

ABC or ddI
+
3TC or FTC
+
LPV/r or ATV/r or SQV/r or DRV/r

CD4 count < 200/mm3:

ABC or ddI
+
3TC
+
EFV or NVP

---------------------

ABC or ddI
+
3TC
+
ATV/r or SQV/r or DRV/r

______
Nigeria Adults and adolescents
2007

All patients with:

  • CD4 count < 200/mm3 at WHO; clinical stage 1 or 2
  • WHO clinical stage 4; or
  • CD4 count < 350/mm3 at WHO clinical stage 3

AZT or TDF
+
3TC or FTC
+
NVP or EFV

TDF or ddI or ABC
+
3TC or FTC
+
LPV/r

______
Nigeria Infants and children
2007

Children < 5 years of age:
Follow age-related CD4% according to WHO

AZT or d4T
+
3TC or FTC
+
NVP

ABC or AZT
+
3TC
+
LPV/r or IDV

______
Pakistan Adults and adolescents
2005

If CD4 testing is available:

  • CD4 count < 200/mm3;
  • WHO clinical stage 4; or
  • Consider treatment when CD4
    count < 350/mm3 and WHO clinical stage 3

If CD4 testing is not available:

  • TLC < 1200/mm3 at WHO clinical stage 2; or
  • WHO clinical stage 3 or 4

AZT
+
3TC
+
NVP

TDF or ABC
+
ddi
+
NFV

______
Panama Infants and children
2007

All infants (< 12 months of age)

Children 1 to 4 years of age with:

  • CD4% < 20%; or
  • AIDS-defining illness or symptoms of advanced disease

Children 4 to 12 years of age with:

  • CD4% < 15%; or
  • AIDS-defining illness or symptoms of advanced disease

Children 12 to 13 years of age with:

  • CD4 count < 200/mm3;
  • AIDS-defining illness or symptoms of advanced disease; or
  • Consider treatment if CD4 count > 200/mm3 and ≤ 350/mm3 with viral load < 100,000 copies/mL

Children < 3 years of age:

AZT
+
3TC or FTC
+
LPV/r or NFV

---------------------

ddI or d4T
+
3TC or FTC
+
LPV/r or NFV

Children > 3 years of age:

AZT
+
3TC
+
EFV or LPV/r

 

______

______
Panama Adults and adolescents
2007

All patients with:

  • CD4 count < 350/mm3; or
  • AIDS-defining illness or symptoms
    of advanced disease

AZT
+
3TC
+
EFV

---------------------

FTC
+
TDF
+
EFV

---------------------

ddI or d4T
+
3TC
+
EFV

AZT
+
3TC
+
LPV/r or ATV/r or SQV/r or IDV/r

______
Papua New Guinea Adults and adolescents
2003

All patients with:

  • CD4 count < 200/mm3;
  • WHO clinical stage 3 or 4; or
  • WHO clinical stage 2 or 3 with TLC < 1200/mm3

d4T or AZT|
+
3TC
+
NVP

ABC
+
ddI
+
LPV/r or SQV/r or NFV

______
Papua New Guinea Infants and children
2003

Children < 18 months of age with:

  • WHO pediatric clinical stage 3
    irrespective of CD4%; or
  • WHO pediatric clinical stage 1
    or 2 with CD4% < 20%

Children > 18 months of age with:

  • WHO pediatric clinical stage 3
    irrespective of CD4%; or
  • CD4% < 15%

d4T or AZT
+
3TC
+
NVP or EFV

ABC
+
ddI
+
LPV/r or SQV/r or NFV

______
Paraguay Adults and adolescents
2009

All patients with:

  • AIDS-defining illness;
  • CD4 count < 350/mm3; or
  • TLC < 1,200/mm3

Patients with CD4 count > 350/mm3 should be considered if:

  • > 55 years of age;
  • Drop in CD4 count of > 120/mm3 per year;
  • Certain comorbidities exist; or
  • Viral load >100,000 copies/mL

AZT
+
3TC
+
EFV or NVP

---------------------

d4T
+
3TC
+
NVP or EFV

---------------------

AZT
+
3TC
+
IDV/r or LPV/r

---------------------

d4T
+
3TC
+
IDV/r or LPV/r

---------------------

TDF
+
FTC
+
LPV/r

---------------------

AZT
+
3TC
+
ABC

TDF
+
FTC
+
LPV/r
±
RAL, MVC or ENF

---------------------

TDF
+
FTC
+
ETV
±
DRV/r or RAL or MVC

---------------------

d4T
+
ddI or 3TC
+
IDV/r or LPV/r

---------------------

TDF
+
FTC
+
ETR or EFV
±
DRV/r or RAL or MVC

---------------------

d4T
+
ddI or 3TC
+
IND/r or LPV/r

TDF
+
FTC
+
LPV/r
±
RAL, MVC or ENF

---------------------

TDF
+
FTC
+
ETR
±
DRV/r or RAL or MVC

---------------------

d4T
+
ddI or 3TC
+
IND/r or LPV/r

---------------------

TDF
+
FTC
+
ETR or EFV
±
DRV/r or RAL or MVC

---------------------

d4T
+
ddI or 3TC
+
IND/r or LPV/r

Resistance testing must be performed. If three fully active drugs cannot be combined, then two fully active drugs combined with other drugs that have some activity can be effective.
Peru Adults and adolescents
2005

All patients with:

  • CDC Category C;
  • Recurrent oral candidiasis;
  • HIV-related symptoms (fever of unknown origin, involuntary weight loss, diarrhea > 1 month);
  • CD4 count < 200/mm3; or
  • Viral load > 55,000 copies/mL

AZT
+
3TC
+
EFV or NVP

---------------------

d4T
+
3TC
+
EFV or NVP

---------------------

ddI, ABC or TDF are acceptable alternatives

2 new NRTIs
+
LPV/r or ATV/r or SQV/r

______
Philippines Adults and adolescents
2009

All patients with:

  • CD4 count < 200/mm3; or
  • WHO clinical stage 3 and 4

Those with a CD4 count > 200/mm3 but < 350/mm3 at WHO clinical stage 3 may be considered for treatment.

AZT + 3TC + NVP or EFV

---------------------

d4T + 3TC + NVP or EFV

AZT or TDF + 3TC + LPV/r

_____
Russia Adults and adolescents
2007

All patients with:

  • CD4 count < 200/mm3

The Ministry of Health of the Russian Federation also recommends treatment if:

  • CD4 count is between 200 and 350/mm3; and
  • Viral load > 100,000 copies/mL

2 NRTIs
+
NNRTI or PI

NRTI backbones:

AZT
+
3TC;

ABC
+
3TC;

Phosphazid
+
3TC;

d4T
+
3TC;

TDF
+
FTC; or

ABC
+
ddI

NNRTIs:

EFV (preferred)

NVP (alternative)

PIs:

LPV/r; IDV/r; SQV/r;

FPV/r; ATV/r, ATV or NFV

Some of the ARVs used in second line regimens are ATV, ATV/r, DRV, and TPV.

Refer to page 38 of the guidelines for further guidance.

______
Rwanda Adults and adolescents
2007

All patients with:

  • CD4 count < 350/mm3; or
  • WHO clinical stage 4

d4T or TDF or AZT
+
3TC
+
NVP or EFV

ABC or AZT or d4T
+
3TC
+
LPV/r or EFV

______
Rwanda Infants and children
2007

Infants < 11 months of age with:

  • CD4 count < 1500/mm3 (25%)

Children 12–35 months of age with:

  • CD4 count < 7500/mm3 (20%)

Children 36–59 months of age with:

  • CD4 count < 350/mm3 (15%)

Children > 5 years of age with:

  • CD4 count < 350/mm3 at WHO pediatric clinical stage 1, 2 or 3; or
  • WHO pediatric clinical stage 4

d4T or AZT
+
3TC
+
NVP

ddI
+
ABC
+
LPV/r

______
Senegal Adults and adolescents
2011

All patients with:

  • CD4 count ≤ 200/mm3;
  • CDC Category B and CD4 count ≤ 350/mm3; or
  • CDC Category C

The choice of first line regimen should be individualized based on potential advantages and disadvantages specific to each patient. Refer to the guidelines for further guidance.

The choice of second line regimen should be individualized based on potential advantages and disadvantages specific to each patient. Refer to the guidelines for further guidance.

______
Sierra Leone Adults and adolescents
2004

All patients with:

  • CD4 count ≤ 200/mm3 (CD4% 15%); or
  • WHO clinical stage 4; or
  • WHO clinical stage 2 or 3 and TLC < 1200/mm3

AZT
+
3TC
+
NVP or EFV

---------------------

d4T
+
3TC
+
NVP or EFV

2 NRTIs
+
PI or PI/r

2 new NRTIs
+
PI/r

---------------------

NRTI
+
NNRTI
+
PI/r
Sierra Leone Infants and children
2004

Children < 18 months of age:

Where virological confirmation is available:

  • WHO pediatric clinical stage 3; or
  • WHO pediatric clinical stage 1 or 2 and CD4% < 20%

Where virological confirmation is not available:

  • WHO pediatric clinical stage 3; and
  • CD4% < 20%

Children > 18 months of age with:

  • WHO pediatric clinical stage 3; or
  • WHO pediatric clinical stage 1 or 2 and CD4% < 15%

Guidelines do not provide specific regimen information for infants and children.

______

______
South Africa Adults and adolescents
2010

All patients with:

  • CD4 count ≤ 200/mm3;
  • WHO clinical stage 4;
  • CD4 count ≤ 350/mm3 and coinfected with TB; or
  • MDR or XDR TB (multidrug-resistant or extensively drug-resistant tuberculosis)

TDF
+
3TC or FTC
+
EFV or NVP

AZT
+
3TC
+
LPV/r

______
South Africa Infants and children
2010

All infants (< 12 months of age)

Children 12 months to 5 years of age with:

  • CD4% ≤ 25% (750/mm3); or
  • WHO pediatric clinical stage 3 or 4

Children > 5 years of age with:

  • CD4 < 350/mm3; or
  • WHO pediatric clinical stage 3 or 4

Children < 3 years of age or weighing < 10kg:

ABC
+
3TC
+
LPV/r

Children > 3 years and weighing > 10kg:

ABC
+
3TC
+
EFV

______

______
Swaziland Adults and adolescents
2006

All patients with:

  • CD4 count < 200/mm3;
  • WHO clinical stage 4; or
  • CD4 count < 350/mm3 at WHO clinical stage 3

AZT or d4T
+
3TC
+
NVP or EFV

ddI or TDF
+
ABC
+
LPV/r

______
Swaziland Infants and children
2006

All children with:

  • WHO pediatric clinical stage 3 or 4 irrespective of CD4 count or percentage; or
  • WHO pediatric clinical stage 1 or 2, if the CD4 immunological stage is “severe”

d4T or AZT
+
3TC
+
NVP

ABC
+
ddI
+
LPV/r

______
Tanzania Adults and adolescents
2005

All patients with:

  • CD4 count ≤ 200/mm3;
  • WHO clinical stage 4; or
  • CD4 count ≤ 350/mm3
    at WHO clinical stage 3

d4T or AZT
+
3TC
+
NVP or EFV

ABC
+
ddI
+
LPV/r

______
Tanzania Infants and children
2005

Children < 18 months of age with:

  • WHO pediatric clinical stage
    3 or 4 irrespective of CD4%; or
  • WHO pediatric clinical stage
    1 or 2 with CD4% < 20%

Children > 18 months of age with:

  • WHO pediatric clinical stage
    3 or 4 irrespective of CD4%; or
  • WHO pediatric clinical stage
    1 or 2 with CD4% < 15%

Children < 3 years of age:

AZT
+
3TC
+
NVP

Children > 3 years of age:

AZT
+
3TC
+
EFV or NVP

ABC
+
ddI
+
LPV/r or NFV

______
Thailand Adults and adolescents
2010

All patients with:

  • CD4 count ≤ 350/mm3; or
  • AIDS-defining illness; or
  • HIV-related symptomatic; or
  • Pregnant women but discontinued after delivery for those women with a pre-treatment CD4 count of ≥ 350/mm3

AZT
+
3TC
+
EFV or NVP

---------------------

TDF
+
3TC or FTC
+
EFV or NVP

Alternative:

ABC
+
3TC
+
EFV

---------------------

d4T*
+
3TC
+
EFV or NVP

---------------------

ddI
+
3TC
+
EFV or NVP

*d4T should be replaced by another NRTI after 6-12 months

If patient cannot tolerate NNRTIs replace with:

Preferred: LPV/r

Alternative: ATV/r or DRV/r or SQV/r

If first regimen was NNRTI-based:

PI/r
+
2 active NRTIs indicated by genotype testing

If first regimen was PI/r-based:

Active PI/r
+
2 active NRTIs indicated by genotype testing

---------------------

Active PI/r
+
1 NNRTI
+
1 NRTI indicated by genotype testing

---------------------

NNRTI
+
2 active NRTIs indicated by genotype testing

(only use this option when there are 2 active NRTIs and the
patient has never been exposed to NNRTI or NRTI monotherapy or duotherapy)

At least 2 new active ARVs such as:

DRV/r, ETV, or RAL

Refer to expert consultation or appropriate clinical trial in cases where these drugs are not available. While waiting for new drugs, a holding regimen consisting of 3TC and other NRTIs may be considered.
Thailand Infants and children
2010

All infants (< 12 months of age)

Children 1 to 5 years of age with:

  • CD4% < 25%; or
  • WHO pediatric clinical stage 3 or 4; or
  • CDC Category B or C

Children > 5 years of age with:

  • CD4 count < 350/mm3; or
  • WHO pediatric clinical stage 3 or 4; or
  • CDC Category B or C

Children < 3 years of age:

AZT
+
3TC
+
NVP

Alternative:

d4T
+
3TC
+
NVP

Children > 3 years of age:

AZT
+
3TC
+
EFV

Alternative:

AZT
+
3TC
+
NVP

---------------------

d4T
+
3TC
+
EFV or NVP

Adolescents (weight > 40kg or Tanner stage IV):

TDF
+
3TC
+
EFV

2 NRTIs
+
PI/r

Select NRTIs guided by genotype of RT gene. Refer to Figure 1 on page 510 of the guidelines for specific second-line regimens recommended for different scenarios.

To design a salvage regimen, use at least 2 active drugs plus a recycled NRTI. Access to new drugs such as DRV, MVC, ETV, and RAL may be needed. Expert consultation is recommended. Refer to page 511 of the guidelines for further guidance.
Uganda Adults and adolescents
2009

All patients with:

  • CD4 count < 250/mm3; or
  • WHO clinical stage 4; or
  • CD4 count > 250 but ≤ 350/mm3 in those:
    • Co-infected with TB; or
    • WHO clinical stage 3; or
    • Pregnant women

AZT
+
3TC
+
NVP or EFV

Alternative 1:

TDF
+
3TC or FTC
+
NVP or EFV

Alternative 2:

d4T
+
3TC
+
NVP or EFV

If first regimen AZT + 3TC + NVP or EFV:

ABC
+
ddI
+
LPV/r

---------------------

TDF
+
3TC or FTC
+
LPV/r

 

If first regimen TDF + 3TC or FTC + NVP or EFV:

AZT
+
ddI
+
LPV/r

---------------------

ABC
+
ddI
+
LPV/r

---------------------

AZT
+
3TC
+
LPV/r

 

If first regimen d4T + 3TC + NVP or EFV:

ABC
+
ddI
+
LPV/r

---------------------

TDF
+
3TC or FTC
+
LPV/r

______
Uganda Infants and children
2009

All infants (< 12 months of age)

Children 12 to 35 months of age with:

  • CD4% ≤ 20% (CD4 count ≤ 750/mm3)

Children 36 to 59 months of age with:

  • CD4% ≤ 20% (CD4 count ≤ 350/mm3)

Children > 5 years of age with:

  • CD4% ≤ 15% (CD4 count ≤ 250/mm3)

Children < 5 years of age:

d4T
+
3TC
+
NVP or EFV

Children > 5 years of age initiating or being switched from d4T-containing regimens:

AZT
+
3TC
+
NVP or EFV

Infants < 12 months initiating ART with previous exposure to NVP or EFV:

d4T
+
3TC
+
LPV/r

If first regimen d4T + 3TC + NVP or EFV:

ABC
+
ddI
+
LPV/r or ATV/r

---------------------

TDF
+
3TC or FTC
+
LPV/r

---------------------

AZT
+
3TC
+
ATV/r

If first regimen AZT + 3TC + NVP or EFV:

ABC
+
ddI
+
LPV/r or ATV/r

---------------------

TDF
+
3TC or FTC
+
LPV/r

If first regimen d4T + 3TC + LPV/r:

ABC
+
ddI
+
NVP or EFV

______
Ukraine Adults and adolescents
2006

All patients with:

  • CD4 count < 200/mm3; or
  • WHO clinical stage 4; or
  • CD4 count < 350/mm3 and WHO clinical stage 3

Consider treatment if:

  • CD4 count > 200 and < 350/mm3 and WHO clinical stage 1 or 2

Preferred:

AZT
+
3TC
+
EFV

---------------------

TDF*
+
FTC or 3TC
+
EFV

Alternative:

AZT
+
3TC
+
NVP

Preferred PI-based regimens:

AZT
+
3TC
+
LPV/r

---------------------

TDF*
+
FTC or 3TC
+
LPV/r

Alternative PI-based regimen:

AZT
+
3TC
+
NFV

*TDF and FTC require registration in Ukraine

If first regimen AZT + 3TC + EFV or NVP:

ddI
+
ABC or TDF or AZT or 3TC
+
LPV/r

---------------------

TDF
+
ABC or (3TC + AZT) or ddI
+
LPV/r

If first regimen TDF + FTC or 3TC + EFV or NVP:

ddI
+
ABC or AZT or (3TC ± AZT)
+
LPV/r

If first regimen AZT + 3TC + LPV/r:

dI
+
AZT or ABC
+
LPV/r

---------------------

TDF
+
ABC or AZT or (3TC ± AZT)
+
LPV/r

If first regimen TDF + FTC + LPV/r:

ddI
+
ABC or AZT
+
LPV/r

If first regimen AZT + 3TC + NFV:

AZT
+
ddI
+
LPV/r

Considerations for salvage regimens:

  • Add 2 active drugs such as ENF and TPV or another new PI
  • A combination of 2 PIs (except for TPV, which is not recommended in combination with other PIs)
Ukraine Infants and children
2007

Infants < 11 months of age:

  • CD4% < 25% (CD4 count < 1500/mm3); or
  • WHO pediatric clinical stage 3 or 4

Children 12 to 35 months of age:

  • CD4% < 20% (750/mm3); or
  • WHO pediatric clinical stage 4; or
  • WHO pediatric clinical stage 3 with specific OIs*

Children 36 to 59 months of age:

  • CD4% < 15% (350/mm3); or
  • WHO pediatric clinical stage 4; or
  • WHO pediatric clinical stage 3 with specific OIs*

Children > 5 years of age:

  • CD4% < 15% (200/mm3); or
  • WHO pediatric clinical stage 4; or
  • WHO pediatric clinical stage 3 with specific OIs*

*TB, LIP, OHL, and thrombocytopenia

Preferred NRTI backbones:

AZT + 3TC

d4T + 3TC

AZT + ddI

ddI + 3TC

Alternative NRTI backbones:

ABC + AZT

ABC + 3TC

d4T + ddI

NNRTIs:

Children < 3 years of age:
NVP

Children ≥ 3 years of age:
EFV

PIs:

LPV/r, NFV

If first regimen AZT or d4T + 3TC + NPV or EFV:

ddI
+
ABC
+
LPV/r or SQV/r or NFV

If first regimen ABC + 3TC + NVP or EFV:

ddI
+
AZT
+
LPV/r or SQV/r or NFV

If first regimen AZT or d4T + 3TC + LPV/r or NFV:

ddI
+
ABC
+
LPV/r or EFV or NVP

If first regimen ABC + 3TC + LPV/r or NFV:

ddI
+
AZT
+
LPV/r or EFV or NVP

If first regimen AZT or d4T + 3TC + ABC:

ddI
+
EFV or NVP
+
LPV/r or SQV/r or NFV

This requires consultation with an experienced professional.

Strategic approaches include:

  • ENF
  • Reuse of ARVs
  • Structured treatment interruption
  • The continuation of current therapy until appropriate drugs are available.
United States Adults and adolescents
2011

All patients with:

  • CD4 count ≤ 350/mm3; or
  • History of an AIDS-defining illness; or
  • HIV-associated nephropathy; or
  • Hepatitis B co-infection when HBV treatment is indicated

ART is also recommended for 1) patients with CD4 count between 350 and 500/mm3, and 2) for pregnant women who do not meet criteria for treatment with the goal to prevent perinatal transmission (refer to Perinatal Guidelines for further guidance).

Adolescents:

Adult ART guidelines are usually appropriate for post-pubertal adolescents. Dosing should be based on Tanner staging of puberty. Refer to the guidelines for further guidance (pg. 94-96).

EFV / TDF / FTC

---------------------

ATV/r or DRV/r or RAL
+
TDF / FTC

Alternative:

EFV
+
(ABC or AZT) / 3TC

---------------------

NVP
+
AZT / 3TC

---------------------

ATV/r
+
(ABC or AZT) / 3TC

---------------------

FPV/r or LPV/r
+
[(ABC or AZT) / 3TC] or TDF / FTC

Patient’s treatment history and former and current resistance test results should be used to identify at least 2 (preferably 3) fully active agents* to combine with an optimized background ARV regimen. Refer to the guidelines for further guidance (pg. 71-73).

*Fully active agent: one that is likely to have ARV activity based on patient’s treatment history, drug-resistance testing and/or a novel mechanism of action.

Refer to the guidelines for guidance (pg. 71-73).
United States Infants and children
2011

All infants (< 12 months of age)

Children ≥ 1 with:

  • AIDS or significant symptoms (CDC Category C or most Category B conditions); or
  • Age-related CD4 threshold (CD4% count ≤ 25% for ages 1 to < 5 years and < 350/mm3 for ≥ 5 years of age) and viral load ≥ 100,000 copies/mL

Children < 3 years of age:

ABC or ddI or AZT
+
3TC or FTC
+
NVP or LPV/r

Alternative:

AZT
+
ABC or ddI
+
NVP or LPV/r

Children > 3 years of age:

ABC or ddI or AZT or TDF*
+
3TC or FTC
+
EFV or LPV/r

Alternative:

AZT
+
ABC or ddI
+
EFV or LPV/r or NVP

Children ≥ 6 years of age:

ABC or ddI or AZT or TDF*
+
3TC or FTC
+
EFV or LPV/r

Alternative:

AZT
+
ABC or ddI
+
ATV/r or DRV/r or FPV/r
+
NVP

*for Tanner Stage 4 or post-pubertal adolescents only

If first regimen 2 NRTIs + NNRTI:

2 NRTIs
+
PI

If first regimen 2 NRTIs + PI:

2 NRTIs
+
NNRTI

---------------------

2 NRTIs
+
PI/r

---------------------

NRTI(s)
+
NNRTI
+
PI/r

If first regimen 3 NRTIs:

2 NRTIs
+
NNRTI or PI

---------------------

NRTI(s)
+
NNRTI
+
PI

When replacing a drug with one of the same class, drug selection should be based on resistance testing.

Refer to guidelines for further guidance (pg. 130-136).
Uruguay Adults and adolescents
2006

All patients with:

  • Acute symptomatic infection
  • HIV-related symptoms
  • CD4 < 250/mm3 irrespective of symptoms and viral load

AZT
+
3TC
+
NVP or IDV/r or SQV/r

---------------------

d4T
+
3TC
+
EFV or NFV

2 NRTIs
+
EFV or NFV or IDV/r or SQV/r

---------------------

2 NRTIs
+
1 NNRTI
+
SQV/r or LPV/r

---------------------

1 NRTI
+
1 NNRTI
+
SQV/r

______
Venezuela Adults and adolescents
2008-2009

All patients with:

  • CDC Category B or C;
  • CD4 count < 200/mm3 and/or <15%;
  • HIV-related nephropathy; or
  • Co-infection with hepatitis B

Consider treatment if:

  • CD4 count ≥ 200/mm3 and ≤ 350/mm3; or
  • Viral load > 100,000 copies/mL

TDF or ABC or AZT or ddI
+
3TC
+
EFV or NVP

---------------------

TDF or ABC or AZT or ddI
+
3TC
+
ATZ/r or FPV/r or LPV/r or SQV/r

---------------------

For co-infection with hepatitis B use a TDF/3TC combination

AZT*
+
ABC
+
FPV/r or LPV/r or SQV/r

---------------------

ddI or TDF
+
AZT* or ABC or 3TC
+
FPV/r or LPV/r or SQV/r

*In case of AZT-induced anemia, switch to d4T

DRV/r
+
RAL
+
T20

See guidelines for further guidance, pg. 39-42.
Venezuela Infants and children
2008-2009

All infants (< 12 months of age) with:

  • CD4% < 25% (< 1500/mm3), which is indicative of severe immunosuppression

Children 1 to 3 years of age with:

  • CD4% < 20% (< 750/mm3); or
  • Any CDC Category B or C symptoms except one episode of a severe bacterial infection

Children 3 to 5 years of age with:

  • CD4 < 15% (350/mm3); or
  • Any CDC Category B or C symptoms except one episode of a severe bacterial infection

Children > 5 years of age with:

  • CD4 count < 200/mm3 (15%); or
  • Any CDC Category B or C symptoms except one episode of a severe bacterial infection

Consider treatment in children from 1 to 5 years of age with:

  • CDC Category A or a single severe bacterial infection;
  • CD4% > 25%; and
  • Viral load > 100,000 copies/mL

Consider treatment in children > 5 years of age with:

  • CDC Category A or N or a single severe bacterial infection;
  • CD4 count > 200/mm3; and
  • Viral load > 100,000 copies/mL

AZT or ddI or ABC
+
3TC
+
LPV/r or NVP (< 3 years of age) or EFV (≥ 3 years of age and > 10kg)

AZT
+
ddI
+
NVP (≥ 3 years of age) or FPV/r (> 6 years of age)

---------------------

ABC
+
AZT
+
NVP (≥ 3 years of age) or FPV/r (> 6 years of age)

---------------------

TDF
+
3TC (adolescents at Tanner stage 4-5)
+
NVP (≥ 3 years of age) or FPV/r (> 6 years of age)

ENF

DRV, RAL: only in adolescents at weight indicated for adult dosage or according to recommended dosages.

Refer to the National Committee for HIV Drug Resistance for further guidance.
Vietnam Infants and children
2005

Children < 18 months of age with:

  • WHO pediatric clinical
    stage 4 irrespective of CD4%; or
  • WHO pediatric clinical
    stage 1, 2 or 3 with
    CD4% < 20%

Consider treatment for all children with:

  • WHO pediatric clinical
    stage 3; or
  • WHO pediatric clinical
    stage 2 with TLC
    < 2500/mm3

---------------------

Children > 18 months of age with:

  • WHO pediatric clinical
    stage 4 irrespective of
    CD4% or count; or
  • WHO pediatric clinical
    stage 1 or 2 with
    CD4% < 15%

Consider treatment for all children with:

  • WHO pediatric clinical
    stage 3; or
  • WHO pediatric clinical
    stage 2 with TLC
    < 1500/mm3

Children < 18 months of age:

AZT or d4T
+
3TC
+
NVP or EFV

Children > 18 months of age:

AZT or d4T
+
3TC
+
NVP or EFV

Children < 18 months of age:

ABC
+
ddI
+
LPV/r or NFV

Children > 18 months of age:

ABC
+
ddI
+
LPV/r or NFV

______
Vietnam Adults and adolescents
2005

All patients with:

  • CD4 count < 200/mm3 at WHO clinical stage 1 or 2;
  • CD4 count < 350/mm3 at WHO clinical stage 3;
  • WHO clinical stage 4; or
  • WHO clinical stage 2 or 3 with TLC ≤ 1200/mm3

d4T or AZT
+
3TC
+
NVP or EFV

ABC or TDF
+
ddI
+
LPV/r or SQV/r or NFV

______
Zambia Adults and adolescents
2007

All patients with:

  • CD4 count < 200/mm3;
  • WHO clinical stage 4; or
  • CD4 count < 350/mm3
    at WHO clinical stage 3

TDF
+
FTC
+
NVP or EFV

AZT or d4T
+
3TC or TDF/FTC
+
LPV/r

______
Zambia Infants and children
2010

All children < 2 years of age

Children ≥ 2 and < 5 years of age with:

  • CD4% ≤ 25% or CD4 ≤ 750 cells/mm3; or
  • WHO pediatric clinical stage 3 or 4

Children ≥ 5 years of age with:

  • CD4 < 350 cells/mm3; or
  • WHO pediatric clinical stage 3 or 4

Infants and children < 24 months of age with no previous NNRTI exposure:

2 NRTIs
+
NVP

Infants and children < 24 months of age with previous NNRTI exposure (i.e. PMTCT):

2 NRTIs
+
LPV/r

Children ≥ 24 months and < 3 years of age:

2 NRTIs
+
NVP

Children > 3 years of age:

2 NRTIs
+
NVP or EFV

Preferential order of NRTI backbone:

AZT + 3TC
ABC + 3TC
d4T + 3TC

If first regimen AZT or d4T + 3TC + NVP or EFV:

ABC
+
3TC
+
LPV/r or

In children > 12 years of age:

TDF
+
FTC or 3TC
+
LPV/r

If first regimen ABC + 3TC + NVP or EFV:

AZT
+
3TC
+
LPV/r

If first regimen AZT or d4T + 3TC + LPV/r:

ABC
+
3TC
+
NVP or EFV

If first regimen ABC + 3TC + LPV/r:

AZT
+
3TC
+
NVP or EFV

Considerations:

  • For older children with more therapeutic options available, it may be possible to construct third-line regimens with novel drugs used for adults (i.e., DRV and RAL).
  • Children on failing second-line regimens with no new ARV options should continue with a tolerated regimen.
  • When stopping ART, management of OIs, symptoms and pain must continue.

For further guidance on the failure of second-line regimens, refer to page 73 of the guidelines.
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