Monitoring Patients on Antiretroviral Therapy

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Monitoring of patients on ART is based on clinical and laboratory parameters. Refer table 6.7 

Table 6.7 Clinical and laboratory monitoring of patients on first line drug regimen 

Regimens 

Monitoring Tests 

Frequency 

Rationale 

TDF+3TC+DTG  ABC+3TC+DTG  AZT+3TC+ (EFV or NVP) 

TDF+FTC+ (EFV or NVP) 

HVL (All Clients) 

For HVL monitoring,  refer to HVL algorithm 

ART monitoring 

CD4 (All clients) 

Baseline (All) 

After every six months if CD4 is <350 cells/ml 

ART monitoring 
FBP/Hb (All clients)  If a client has Hb <8.5g/dl avoid AZT  Baseline, week 4,  thereafter six monthlies  Anaemia monitoring 

Serum Creatinine  (For patients on  TDF)

 Baseline, and after  every six months and  whenever symptomatic  Screening for early renal  toxicity

ALT (For patients  on DTG or NVP) 

 Baseline, one month,  after every six months  and whenever  symptomatic  Liver toxicity 
AZT+3TC+ATV/r  TDF+FTC+ATV/r  ABC+3TC+LPV/r or DTG 

 

 Bilirubin (For all  clients on ATV/r) Baseline, 6 months or whenever symptomatic  Indirect hyper- bilirubinaemia

Note: Clinical evaluation will determine more frequent laboratory tests if required. 

Laboratory monitoring of patients on second line drugs 

The following laboratory tests are recommended for monitoring of patients on second line drugs: 

  • FBC, baseline, then monthly for 3 months, then after every 6 months (with CD4 and viral load) 
  • Fasting cholesterol and triglyceride, baseline, 6 months and thereafter every 12 months 
  • Liver function tests, (ALT) 6 monthly 
  • Fasting glucose, every 12 months 
  • Urinalysis at baseline and after every 3 months 
  • Serum creatinine at baseline and once a year. 

When changing treatment, the following should be observed: 

  • Never  change  a  single  drug  in  the  combination  if  the  reason  for  changing  is  treatment failure. Change at least two drugs, preferably change all three drugs 
  • If changing due to toxicity, change only the drug suspected to be causing the problem
  • Never change to monotherapy (i.e. single drug)  
  • When selecting drugs, choose drugs that have not been used before, drugs which do not have cross-resistance/or no overlapping toxicities or drug-drug interactions.  
  • Lamivudine has advantage of decreasing viral fitness therefore it may be retained when changing the failing regimen