4. The comprehensive care team managing the patient Spouse/partner Other family and friends Community services Spiritual Care givers Occupational therapist Physiotherapist Doctors Nurses Counsellor Nutritionist
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26. ART and TB: When to start Start anti-TB treatment Consider clinical status: start ART as appropriate CD4 count not available Start anti-TB treatment Start ART after completion of TB treatment CD4 count 200-350/mm 3 Start anti-TB treatment Start ART after intensive phase CD4 count 100-200/mm 3 Start anti-TB treatment Start ART as soon as possible CD4 <100/mm 3 Treatment Recommendation CD4 Count
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Editor's Notes
To introduce the concept of holistic approach for HIV care. ART is one of the components of Physical care for HIV patient
*e.g pregnant mother in the first trimeatre with TB who requires both anti-TB and ARV treatment to be commenced
All patients with a CD4 count < 200 should be started on treatment.
Much can be learned form the successful National TB programs which have incorporated use of standardized TB regimens. The success of National TB programs has been due to the simplification of treating many patients. In the last half of 2002 the Kenyan ARV task force made recommendations on standardized ARV regimens. The 1 st line regimen consisting of 2 nucleoside analogues namely stavudine and Lamivudine and Non-Nucleoside analogue either Nevirapine or Efavirenz. This first line regime if properly adhered to should be effective for at least 1 year The second line ARV regime is Protease Inhibitor based: Includes 2 Nucleoside analogues (which should not be in the 1 st line regimen) and a protease inhibitor either Kaletra which contains Lopinavir and ritonavir that boosts blood levels of Lopinavir the pother alternative PI is Nelfinavir. If this 2 regimens fail desinging a third is more difficult with a standardized apprach than an individualised one
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