Management of Pregnant and Breastfeeding Women defaulters or Failing Therapy

exp date isn't null, but text field is

• Due to the risk of the transmission of HIV to the unborn or breastfeeding infant, pregnant or breastfeeding women who present to care with unsuppressed viral load or who have defaulted treatment must be switched to effective therapy (second-line if they previously took a first-line or third-line if they previously took second-line) immediately while the EAC is in process. DTG-based regimens are recommended in this situation.

When to stop ART

Patients may choose to postpone or stop therapy, and providers, on a case-by-case basis, may elect to defer or stop therapy based on clinical and/or psychosocial factors.

The following are indications for stopping ART:

• Patient’s inability to tolerate all available ARV medications
• Patient’s request to stop after appropriate counselling
• Non-adherence despite repeated counselling: treatment should be stopped to avoid continued toxicity, continued evolution of drug resistance, and transmitting drug-resistant HIV
• Unreliable caregiver
• For children, the caregiver is instrumental in ART adherence. Any factors that affect the capability for the caregiver to give medications consistently may be an indication to stop ART in an HIV-infected child.
• Serious drug toxicity or interactions
• Intervening illness or surgery that precludes oral intake
• ARV non-availability

How to stop ART

• Stop ALL the drugs when discontinuing therapy
• Discontinue EFV; continue the NRTI components (backbone) for 1-2 additional weeks
• Preventive measures, such as condom use and safer sex practices, should be strongly emphasized for all patients, especially those discontinuing treatment.