Neobook — clinical reference

If a child is taking an old ARV regimen, change to the corresponding new regimen once the child meets the criteria for switching
Make sure all the requirements for switching are met (age, weight, Viral Load (VL), renal function if switching to TDF)
If the child is taking a regimen with LPV/r, make sure this is a first line regimen. Do not switch if the child/ adolescent is on a second line regimen
If the child did not have a VL in the last 6 months, do not do additional VL outside the routine monitoring. Wait for the result of the next routine VL before switching
For adolescent girls in childbearing age, provide information on risks and benefits of DTG to enable the girl/ caregiver to make an informed choice to either stay on EFV or switch to DTG
Dose according to the paediatric ART dosing chart

Test	Current first line regimen	New first line regimen	Requirements before switching
Infants >4 weeks of age and>42 weeks gestational age	AZT + 3TC + NVP	ABC + 3TC + LPV/r	VL is not required before switching If body weight is <3 kg, obtain expert advice on dosing
Children and adolescents weighing ≥20 kg	ABC + 3TC + LPV/r* OR ABC + 3TC + EFV	ABC + 3TC + DTG	If VL <50 copies/mL in the last 6 months or alternatively VL 50–999 copies/mL twice in the last 6 months, provided adequate assessment (cause of elevated VL) and enhanced adherence counselling is provided. If VL >1000 copies/mL on 2 successive tests, refer to doctor.
Children and adolescents weighing ≥35 kg and≥10 years of age	ABC + 3TC + LPV/r* OR ABC + 3TC + EFV	TDF + 3TC + DTG	If VL <50 copies/mL in the last 6 months or alternatively VL 50–999 copies/mL twice in the last 6 months, provided adequate assessment (cause of elevated VL) and enhanced adherence counselling is provided. If VL >1000 copies/mL on 2 successive tests, refer to doctor. Estimated GFR >80 mL/min is required for starting TDF.

*Ensure that the patient is taking a first line regimen with LPV/r and not a second line regimen.

Integrated Management of Childhood Illness 2022; Anti-Retroviral Therapy; Switching ART

Last checked for updates: June 2023