Table of Contents Acronyms ...................................................................................................... 43 1. Introduction:........................................................................................... 45 2. Objectives and Targets:.......................................................................... 46 2.1 Objectives of this guideline are to: .................................................. 46 2.2 Targets of this guideline are:............................................................ 46 3. Antiretroviral Therapy in adults and adolescents: ..................................... 46 3.1. Goals of Antiretroviral Therapy ………………………………………..47 3.1.1 The primary goals: ............................................................................ 47 3.1.2 The secondary goals:......................................................................... 47 3.2 Initiation of Antiretroviral Therapy in adults and adolescents ............... 48 3.2.1 General consideration ...................................................................... 48 3.2.2 Clinical assessment of HIV-infected adults and adolescents ........... 48 3.2.3 Immunologic assessment of HIV-infected adults and adolescents .. 49 3.2.4 Clinical and Immunologic criteria to initiate antiretroviral therapy 50 4. First-line ARV Regimens for Adults and adolescents in Ethiopia ........... 50 5. Essential steps in baseline assessment, initiation of ART and follow up of patients ............................................................................... 51 6. What to expect in the first six months of ART .......................................... 54 6.1. Early ARV toxicity and intolerance 54 6.2. Rapid reduction in viral load 55 6.3. Immune recovery 55 6.4. Immune Reconstitution Inflammatory Syndrome (IRIS) 56 6.5. Mortality is high 56 7. Second-line regimens for adults and adolescents in Ethiopia 57 8. TB-HIV co-management 60 8.1 In co-managing TB-HIV there are two scenarios to consider 61 8.2. Patient on anti-TB or newly diagnosed active TB 61 9. HIV-Hepatitis co-infection 64 10. Use of ARV in women of child-bearing potential or pregnancy 65 10.1 Women who become pregnant while on ART 66 10.2 Pregnant women eligible for ART 66 10.3 Pregnant women not eligible for ART 67 10.4 Monitoring therapy during antenatal care 67 10.5 Monitoring Therapy during delivery 68 10.6 Care after delivery until 6-weeks postpartum 68 11. Adherence 70 11.1. General Considerations 70 11.2 Role of the Health Care Team in Adherence Assessment, Support and Monitoring 70 12. Management of adverse ARV drug reactions 72 12.1 Strategies for managing adverse drug reactions 72 12.2 Grading adverse reactions in adults and adolescents 73 12.3 Some complications and their management 75
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