Switch to 2nd Line ART if there is clinical, immunologic and virologic failure

Clinical Failure Virological Failure Immunological failure

SWITCH IF: SWITCH IF: SWITCH IF:

1.You discover a new or recurrent WHO stage 3or 4 condition in adult patient who has spent at least 6 months on ART and the patient has 90-100% adherence

1.The initial viral load is ≥1000copies/ml, adherence counselling commences only to discover that a repeat viral load 3months after shows persistent viral load ≥ 1000 copies/ml despite 90-100% by the patient

1. For adults and adolescents, CD4 cell count fall below the baseline CD4 value or is persistently below 100 cell/mm32. for children < 5 years, when CD4 is persistently below 200 cell or less than 10% of the peak value3.For children > 5 years, when CD4 cell count is persistently less than 100 cell/mm3

2.You discover a new or recurrent WHO stage 3 or 4 condition in a child who has been on at least 6 months of ART but this condition must not be TB3.Patient condition continue to deteriorate e.g. losing weight at every clinic, child lose neurodevelopmental milestones, development of AIDS-related encephalopathy4.the above symptoms are not worsening of old OIs client has before ART started

5.Adherence is 90-100% in all above cases

WHEN SHOULD I SWITCH TO SECOND LINE ART

NB: Second line ART is also indicated and preferred in high risk exposure injury i.e. large bore or deep needle injury, source patient is symptomatic with high viral load or when large blood volume is splashed on a non-intact mucosa.