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Module 2:  Anti Retroviral Therapy in Adults and Adolescent Unit 2: When to initiate Highly Active Anti Retroviral Therapy (HAART)
UNIT 2: Objectives ,[object Object],[object Object],[object Object],[object Object]
SPIRITUAL THE PERSON EMOTIONAL PHYSICAL SOCIAL Holistic care
The comprehensive care team managing the patient Spouse/partner Other family and friends Community services Spiritual Care givers Occupational therapist Physiotherapist Doctors Nurses Counsellor Nutritionist
ART is part of the comprehensive care of HIV infection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
AIM OF ART ,[object Object],[object Object]
Principles of ART ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Principles of ART cont’d ,[object Object],[object Object],[object Object],[object Object]
Characteristics of good HAART ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
HAART…….Cont. ,[object Object]
HISTORY OF ART ,[object Object],[object Object],[object Object],[object Object],[object Object]
Goals of ART ,[object Object],[object Object],[object Object],[object Object]
1. Suppression of HIV Replication ,[object Object],[object Object],[object Object],[object Object],[object Object]
2. Immune Reconstitution ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
3. Improvement of QOL ,[object Object],[object Object],[object Object],[object Object],[object Object]
Take-home Messages  about ART ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Take-home Messages  about ART ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Antiretroviral drugs: best practice  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PROTOCOL FOR ART REGIMEN ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
BASELINE INVESTIGATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],For Monitoring ARV Hb CBC LFT RFT Blood sugar Urine Stool & S. Cholesterol S.Triglycerides S. Uric acid S.Creatinine S. Lactic acid S. Amylase Prognostic Investigations CD4 lymphocyte enumeration Plasma Viral load assays
When to Start ART in Adults and Adolescents ,[object Object],[object Object],[object Object]
When to Start ART in Adults and Adolescents ,[object Object],[object Object],[object Object],[object Object]
Guidance on Clinical Criteria ,[object Object],[object Object],[object Object],[object Object]
TB/HIV Co-infected Patients ,[object Object],[object Object],[object Object],[object Object],[object Object]
ART and TB: When to start Start anti-TB treatment Consider clinical status: start ART as appropriate CD4 count not available Start anti-TB treatment Start ART after completion of TB treatment CD4 count 200-350/mm 3 Start anti-TB treatment Start ART after intensive phase CD4 count 100-200/mm 3 Start anti-TB treatment Start ART as soon as possible  CD4 <100/mm 3 Treatment Recommendation CD4 Count
ART and TB  ,[object Object],[object Object]
Rationale Behind Standardized ARV Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
National Standard 1 st  Line Regime  for Adults and Adolescents ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],or
Standard 2nd Line Regime  for Adults and Adolescents ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],or
For Patients on Non-standard 1 st  line Regimes… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
A note on Fixed Dose Combinations (FDC’s) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pregnancy and ART ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Patient Preparation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Considerations prior to starting ART ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
When to Start: Early Initiation of Antiretroviral Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
When to Start: Delayed Initiation of  Antiretroviral Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Summary ,[object Object],[object Object],[object Object],[object Object]
[object Object]

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02.02 adult art initiation gsn

  • 1. Module 2: Anti Retroviral Therapy in Adults and Adolescent Unit 2: When to initiate Highly Active Anti Retroviral Therapy (HAART)
  • 2.
  • 3. SPIRITUAL THE PERSON EMOTIONAL PHYSICAL SOCIAL Holistic care
  • 4. The comprehensive care team managing the patient Spouse/partner Other family and friends Community services Spiritual Care givers Occupational therapist Physiotherapist Doctors Nurses Counsellor Nutritionist
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  • 26. ART and TB: When to start Start anti-TB treatment Consider clinical status: start ART as appropriate CD4 count not available Start anti-TB treatment Start ART after completion of TB treatment CD4 count 200-350/mm 3 Start anti-TB treatment Start ART after intensive phase CD4 count 100-200/mm 3 Start anti-TB treatment Start ART as soon as possible CD4 <100/mm 3 Treatment Recommendation CD4 Count
  • 27.
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Notes de l'éditeur

  1. To introduce the concept of holistic approach for HIV care. ART is one of the components of Physical care for HIV patient
  2. *e.g pregnant mother in the first trimeatre with TB who requires both anti-TB and ARV treatment to be commenced
  3. All patients with a CD4 count &lt; 200 should be started on treatment.
  4. Much can be learned form the successful National TB programs which have incorporated use of standardized TB regimens. The success of National TB programs has been due to the simplification of treating many patients. In the last half of 2002 the Kenyan ARV task force made recommendations on standardized ARV regimens. The 1 st line regimen consisting of 2 nucleoside analogues namely stavudine and Lamivudine and Non-Nucleoside analogue either Nevirapine or Efavirenz. This first line regime if properly adhered to should be effective for at least 1 year The second line ARV regime is Protease Inhibitor based: Includes 2 Nucleoside analogues (which should not be in the 1 st line regimen) and a protease inhibitor either Kaletra which contains Lopinavir and ritonavir that boosts blood levels of Lopinavir the pother alternative PI is Nelfinavir. If this 2 regimens fail desinging a third is more difficult with a standardized apprach than an individualised one