ART Eligibility
All people living with HIV (PLHIV) are eligible to start ART regardless of age, CD4 cell count and clinical stage. For all clients without contra-indications, ART should be initiated within 7 days, and on the same day if possible. Pregnant women, infants and children under five years, and clients with advanced HIV disease should be prioritised for rapid initiation. Many clients (including pregnan
All people living with HIV (PLHIV) are eligible to start ART regardless of age, CD4 cell count and clinical stage.
For all clients without contra-indications, ART should be initiated within 7 days, and on the same day if possible.
Pregnant women, infants and children under five years, and clients with advanced HIV disease should be prioritised for rapid initiation. Many clients (including pregnant women) may be able to initiate ART on the same day as their HIV diagnosis, provided that they are clinically well, and are motivated to start ART.
While rapid, and same-day ART initiation is encouraged where possible, all clients, particularly those with advanced HIV disease, should be carefully assessed for opportunistic infections (OIs) that may necessitate ART deferral.
Medical Indications to Defer ART
| Indication | Action |
| TB symptoms (cough, night sweats, fever, recent weight loss) | Investigate symptomatic clients for TB before initiating ART. If TB is excluded, proceed with ART initiation and TB preventive therapy (after excluding contraindications to TPT). If TB is diagnosed, initiate TB treatment and defer ART. The timing of ART initiation will be determined by the site of TB infection and the client’s CD4 cell count |
| Diagnosis of drug-sensitive (DS) TB at a non-neurological site (e.g. pulmonary TB, abdominal TB, or TB lymphadenitis) |
Defer ART initiation as follows:
|
| Diagnosis of drug-resistant (DR) TB at a non-neurological site (e.g. pulmonary TB, abdominal TB, or TB lymphadenitis) | Initiate ART after 2 weeks of TB treatment, when the client’s symptoms are improving, and TB treatment is tolerated |
| Diagnosis of DS-TB or DR-TB at a neurological site (e.g. TB meningitis or tuberculoma) | Defer ART until 4-8 weeks after the start of TB treatment |
| Signs and symptoms of meningitis | Investigate for meningitis before starting ART |
| Cryptococcal antigen (CrAg) positive in the absence of symptoms or signs of meningitis and if lumbar puncture is (LP) negative for cryptococcal meningitis (CM) | No need to delay ART. ART can be started immediately |
| Confirmed cryptococcal meningitis | Defer ART until 4-6 weeks of antifungal treatment has been completed |
| Other acute illnesses e.g. Pneumocystis jirovecii pneumonia (PJP) or bacterial pneumonia | Defer ART for 1-2 weeks after commencing treatment for the infection |
| Clinical symptoms or signs of liver disease |
Confirm liver injury using ALT and total bilirubin levels. ALT elevations > 120 IU/L with symptoms of hepatitis, and/or total serum bilirubin concentrations > 40 μmol/L are significant. Investigate and manage possible causes including TB, hepatitis B, drug-induced liver injury (DILI), or alcohol abuse |
| Note: Clients who are already on ART should NOT have their treatment interrupted upon diagnosis of the above conditions | |
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2023 ART Clinical Guidelines for the Management of HIV in Adults, Pregnancy and Breastfeeding, Adolescents, Children, Infants and Neonates
June 2023 Version 4
Upload date: 28/07/2023