RDU ART

DR. REID
An 18 year old orphan girl living with her grandmother in Epworth is newly diagnosed with
vertically acquired HIV.

1. What would you start her on and why?

A. Efficacy
Tenolam E
• better suited because she has a high risk of falling pregnant;
• Pregnancy and TB use Efavirenz 600mg not 400mg
• Age;
• Age bearing
• Efavirenz - Highest risk of developing resistance
Tenolam D
• Dolutegravir - Very robust against resistance; most robust against resistance

B. Safety
➡ Side effects of NNRTIs
• Rash
• Liver toxicity

➡ Side effects of Daltegravir

• Increased neural tube defects in the first trimester
• In Zim any woman can access Tenolam D when their risk of pregnancy is low and they are on
adequate contraception
• It is the most efficacious ARV in terms of rapid viral suppression
• Most anticonvulsants cause neural tube defects
• Women on Daltegravir should be put on Folic acid

C. Suitability
• they are both one pill a day

D. Cost & Affordability

• Efavirenz cheaper than Dolutegravir

2. What factors would affect her adherence?

• Retrospective grief - why didn’t anyone tell me?
• Prospective grief - “I had a future but now my life is changed forever”
• Grief Process (DABDA)
• Denial
• Anger
• Bargaining
• Depression
• Acceptance
• 65% non-adherence rate for adolescents living with HIV
• Know how the grief will manifest
• Know how the depression will manifest
3. How to prescribe
Writing a Prescription
Date
Name
Address
Age particularly if the person is below 5 years old
Phone number of the patient
Your qualifications
Practice address
Practice phone number

Prescribe the drug

Tenofovir 300mg/Lamivudine 300mg/Dolutegravir 50mg
Fixed dose combination
Amoxicillin 250mg II TDS PO 5/7
Using Roman numerals to denote the number of tablets to be taken

UK
• Od
• Bd
• TDS
• Qds

American
• Qd
• Bid
• Tid
• Qid
Rx- treat

4. Patient education & knowledge of the drug

How- how do the drugs work
Why- why is adherence so important- need to take 95% of the medication every month to avoid
resistance
What- what are the drugs
When- when do they take the medication
Side Effects
Drug Interactions
Follow up
Support- treatment buddy
Hope- life, marriage
IRIS syndrome

Advise
1. As long as she takes her pills she can live as long as her peers
2. She can marry- undetectable=untransmissable (U=U).
3. Give hope