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Medicines for HIV and AIDS

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HealthWiki > A Book for Midwives > Medicines: uses, dosage, and precautions for the medicines referred to in this book > Medicines for HIV and AIDS


No medicines can cure HIV yet. But people who have HIV can live much longer, healthier lives by taking antiretroviral therapy (ART), a combination of several medicines that must be taken every day. ART medicines also help prevent the spread of HIV to a baby during pregnancy and birth. Check with your local health authority about what ART medicines are available where you live and how to use them.

See more information about HIV infection and how it spreads. Also see another medicine, cotrimoxazole, that can prevent many infections in people with HIV.

Where can a woman get ART? ART medicines are available from HIV or AIDS treatment programs, from clinics and hospitals, and from programs for prevention of mother-to-child (or parent-to-child) transmission, called PMTCT or PPTCT programs. In many places, the medicines are free. A woman taking ART should have regular health care visits about how the ART is affecting her health.

When do women start ART? The best way to know when to start ART is by having a CD4 test, a blood test that measures the strength of the immune system. Most people start ART when their CD4 count is less than 350 (a healthy CD4 count is over 800). When CD4 tests are not available, ART may be started based on the kinds of illnesses a woman has. Women with HIV and tuberculosis should start ART 2 to 8 weeks after beginning treatment for tuberculosis, no matter what their CD4 count is. Women with HIV and hepatitis B should also start ART as soon as possible.

All pregnant women with HIV should take ART, either for their own health or for a limited period of time to protect the baby from HIV. For best protection of the baby, a woman should start taking ART medicines as soon as possible after 14 weeks (3 ½ months) of becoming pregnant.

Contents

Before starting ART:

Which medicines to use or when to start ART may depend on the woman’s health. A health worker will consider conditions such as pregnancy, severe illness or long-lasting fever, anemia, tuberculosis, diabetes, heart disease, or hepatitis, as well as whether she has ever taken ART in the past. Women who live in areas where there is a lot of tuberculosis should talk to a health worker about taking isoniazid to prevent TB.

Women who take ART must take it every day, without fail. If a woman stops taking ART, her HIV will start making her ill again. Taking ART some days and not others lets HIV become resistant to the medicines. This means that those medicines will no longer work as well to treat her. A midwife, as well as people who manage ART programs, can work to ensure there is a steady supply of ART for people with HIV.

Talking to another person using ART can help a woman find ways to deal with difficult side effects of the medicines. Also, someone within her family who knows she has HIV can help remind her to take her medicines every day. Keeping HIV a secret can make it difficult to take medicines at the right time.

What medicines are in ART? Usually 3 or 4 medicines make up a woman’s ART combination. Sometimes 2 or 3 medicines are combined in 1 pill. In some places, women are tested to see what medicines will be best for them. Where testing is not available, a few combinations that work well for most women are used. We show some common combinations here. These same medicines can be used during pregnancy, birth, and breastfeeding to protect the baby from HIV.

How to take ART
  • Take your medicines every day, at the same time each day.
  • If medicines need to be taken 2 times a day, leave 12 hours between the 2 doses. For example, if you take the morning dose at 6:00, then the second dose should be taken at 6:00 in the evening. Having too little medicine in your body can cause drug resistance.
  • If you forget to take a dose on time, try to take it within 5 hours. If it is more than 5 hours late, wait until it is time for the next dose.
  • Do not stop taking any ART medicine without seeing a health worker to find out if your medicines should be stopped separately or all at the same time.
Side effects of ART

ART has helped many people live longer, healthier lives. But like many other medicines, ART can have side effects. People often find that as they get used to the medicines, many side effects lessen and may go away completely. Common side effects for ART are diarrhea, tiredness, headaches, and stomach problems such as nausea, vomiting, stomach pain, or not feeling like eating. Even if you feel bad, keep taking all your medicines until your health worker tells you to change or stop.

Some serious side effects are signs that one of the medicines needs to be changed. Serious side effects include tingling or burning feelings in the hands and feet, fever, rashes, yellow eyes, tiredness along with shortness of breath, anemia and other blood problems, and liver problems. If you have serious side effects, see a health worker right away.

Preventing HIV soon after a woman has been exposed

Midwives or others are sometimes exposed to HIV while doing health work. For example, someone might stick herself with a needle that was used on someone with HIV. Many women are also exposed to HIV through rape. If you think you have been exposed to HIV (see how HIV is spread), it is sometimes possible to prevent getting HIV by taking ART medicines for a short time. This is called Post Exposure Prophylaxis or PEP. Talk with a health worker you trust as soon as possible about whether starting PEP is the best decision for you.

PEP works best if you start taking medicines within a few hours, and no later than 3 days, after exposure. Start one of the ART combinations in the box “ART Combinations for women with HIV” below, preferably Combination 2 or 4. Other medicines may be available and recommended in your area. Whichever combination you use, the medicines must be taken for 28 days.

ART Combinations for women with HIV (not for children)
Combination 1
Medicines Dose Warnings
and side effects
Advantages of
combination
zidovudine
(AZT)
250 to 300 mg
2 times a day
Anemia
Low white blood count
  • Most widely used
    and available
  • Safe for pregnant
    women
lamivudine
(3TC)
150 mg 2 times a day,
or 300 mg once a day
nevirapine
(NVP)
200 mg once a day for
14 days, then 200 mg
2 times a day
Skin rash
Liver problems
Combination 2
Medicines Dose Warnings
and side effects
Advantages of
combination
tenofovir
(TDF)
300 mg once a day Can cause kidney problems
For use by women over
18 years old
  • Fewer side effects
  • Safe for pregnant
    women
  • Combination for
    women with HIV
    and hepatitis B
lamivudine
(3TC)
150 mg 2 times a day, or
300 mg once a day
nevirapine
(NVP)
200 mg once a day for
14 days, then 200 mg
2 times a day
Skin rash
Liver problems
Combination 3
Medicines Dose Warnings
and side effects
Advantages of
combination
zidovudine
(AZT)
250 to 300 mg
2 times a day
Anemia
Low white blood count
  • Combination if on
    rifampicin for TB
lamivudine
(3TC)
150 mg 2 times a day,
or 300 mg once a day
efavirenz
(EFV)
600 mg once a day

WARNING!

Dizziness, confusion, mood
changes

Should not be taken in first 3 months of pregnancy; it can cause birth defects
Combination 4
Medicines Dose Warnings
and side effects
Advantages of
combination
tenofovir
(TDF)
300 mg once a day Can cause kidney problems
For use by women over
18 years old
  • May be available as one pill, taken once daily
  • Combination if on rifampicin for TB
  • Combination for women with HIV and hepatitis B
lamivudine
(3TC)
150 mg 2 times a day, or
300 mg once a day
efavirenz
(EFV)
600 mg once a day

WARNING!

Dizziness, confusion, mood changes

Should not be taken in first 3 months of pregnancy; it can cause birth defects

WARNING!   Many people still take stavudine (d4T) instead of zidovudine in Combinations 1 and 3. However, stavudine can cause serious side effects with long-term use. Most HIV treatment programs are replacing stavudine with other, safer medicines. If you use stavudine, take the lower dose of 30 mg twice daily.

Preventing HIV in babies

A woman who is already on ART when she becomes pregnant should continue taking it. When her baby is born, he will also need to be given medicine for a few weeks. See below.

Even if a woman with HIV is not taking ART for her own health, ART medicines can be taken during pregnancy and breastfeeding, and given to the baby after birth to prevent HIV from spreading to the baby. Used in this way, the medicines are given for a limited period of time, not life-long like ART. This is sometimes called prevention of mother-to-child transmission.

Medicines are only one part of preventing HIV in a baby. Safer sex during pregnancy, safe birth practices, careful feeding of the baby, and treatment of illnesses in both mother and child are also important to prevent babies from getting HIV.


ART medicines to prevent HIV in babies (mother-to-child transmission)
If the mother IS already taking ART, she should continue taking her medicines and also give the baby the medicines listed in Option 1.


If the mother IS NOT taking ART, she and her baby should take the medicines listed in Option 1 or in Option 2 to prevent HIV infection in her baby. Use medicines recommended and available in your country.
Option 1
FOR THE MOTHER FOR THE BABY
Start taking one of the combinations of ART as soon as possible. It is best to use a combination that does not contain EFV in the first 3 months of pregnancy. You will need to take ART medicines every day for the rest of your life. Whether or not the baby is breastfeeding, the baby should be given:
  • AZT (ZDV, zidovudine), oral suspension, 4 mg/kg, 2 times a day for 6 weeks, OR
  • NVP (nevirapine), oral suspension, 2 mg/kg, once a day for 6 weeks.
Option 2
FOR THE MOTHER FOR THE BABY
During pregnancy, starting as soon as possible from 14 weeks of becoming pregnant she should take:
  • AZT (ZDV, zidovudine), 300 mg, 2 times a day.

During labor, she should take:

  • NVP (nevirapine), 200 mg, in a single dose when labor starts, AND
  • 3TC (lamivudine), 150 mg, when labor starts, and every 12 hours until the baby is born, AND
  • continue taking AZT (ZDV, zidovudine), 300 mg, 2 times a day.

After the birth, she should continue taking for 7 days:

  • 3TC (lamivudine), 150 mg, 2 times a day, AND
  • AZT (ZDV, zidovudine), 300 mg, 2 times a day.
Immediately after birth, the baby should be given:
  • NVP (nevirapine), 2 mg/kg oral suspension (or 6 mg)

If the mother is on ART treatment, continue giving the baby this NVP dose every day for 6 weeks.

If the mother is NOT on ART treatment and is NOT breastfeeding, continue giving the baby this NVP dose every day for 6 weeks.

If the mother is NOT on ART treatment and IS breastfeeding, continue giving the baby this NVP dose every day until 1 week after she stops breastfeeding.


Pregnant women need to take special care

Breastfeeding women need to take special care

WARNING!
efavirenz  (EFV)

Efavirenz is used in combination with other medicines to treat HIV.

Often comes in:
Capsules: 50 mg, 100mg, 200 mg
Tablets: 600 mg
Oral solution: 150 mg/5 ml.
How to use:
For HIV, give 600 mg once a day, along with other medicines.
Information you
should know
If EFV is given to a person who also taking rifampicin for tuberculosis (TB), a higher dose of EFV may be needed (800 mg instead of 600 mg).

To treat HIV, you must give EFV with other medicines. It is important to take this medicine every day, in the recommended dose.
Side effects
EFV may cause dizziness, confusion, mood changes, and strange dreams. These will usually go away after 2 to 4 weeks. If they do not, or if they get worse, see a health worker.

Seek care immediately for signs of allergy: red or purple areas on the skin, rashes or other spreading skin problems, fever, mental health problems.
Warning
Women in the first 3 months of pregnancy should not take EFV. It can cause birth defects. Women taking EFV who may become pregnant should consider switching to a different ART medicine.


Pregnant women need to take special care

Breastfeeding women need to take special care

WARNING!
lamivudine   (3TC)

Lamivudine is used in combination with other medicines to treat HIV, and to prevent passing HIV to a baby.

Often comes in:
Tablets: 150 mg
Oral solution: 50 mg per 5 ml.
How to use:
For HIV, give 150 mg by mouth 2 times a day, or 300 mg once a day, along with other medicines.

To prevent HIV from passing to a baby during birth, give the mother 150 mg as labor starts, every 12 hours during labor, and, if she is breastfeeding, every 12 hours for 7 days after the baby is born.
Information you
should know
To treat HIV, you must give 3TC with other medicines. It is important to take this medicine every day, in the recommended dose.
Side effects
Side effects are rare.

Seek care immediately for belly pain, nausea, vomiting, extreme tiredness with difficulty breathing, or muscle pain.


Pregnant women need to take special care

Breastfeeding women need to take special care

WARNING!
nevirapine   (NVP)

Nevirapine is used in combination with other medicines to treat HIV, and to prevent passing HIV to a baby during birth.

Often comes in:
Tablets: 200 mg
Suspension: 50 mg per 5 ml.
How to use:
For HIV, give 200 mg by mouth once a day for 14 days, then give 200 mg 2 times a day, every day. Also give other medicines.

To prevent HIV from passing to a baby during birth

For a woman who has not taken medicines for HIV during pregnancy, give 200 mg by mouth when labor begins, along with other medicines.

For any baby born to a woman with HIV, give the baby 2 mg for each kilogram of weight (or 6mg) immediately after the birth. Then give 2 mg/kg to the baby for 6 weeks if the mother is not breastfeeding. If she is breastfeeding, give 2 mg/kg of NVP to the baby until 1 week after breastfeeding has ended.
Information you
should know
To treat HIV, you must give NVP with other medicines. It is important to take this medicine every day, in the recommended dose. If a woman uses NVP alone to prevent passing HIV to her child in birth, it may not work as well to treat her own HIV later. For fewer allergic reactions, which can be a problem with NVP, give once a day for the first 14 days.
Side effects
Rash, fever, nausea, headache.

Seek care immediately for signs of allergy: red or purple areas on the skin, rashes or other spreading skin problems, fever, yellow skin or eyes, or swollen liver.
Warning
Nevirapine can cause serious problems in the liver. Stop giving this drug if the person has signs of hepatitis. It should never be restarted.

Women with CD4 counts over 250 are more likely to have an allergic reaction to nevirapine. If possible, they should use another ART medicine.



Pregnant women need to take special care

Breastfeeding women need to take special care

WARNING!
tenofovir   (TDF)

Tenofovir is used in combination with other medicines to treat HIV.

Often comes in:
Tablets: 300 mg.
How to use:
For HIV , give 300 mg once a day. You must also give other medicines.
Information you
should know
To treat HIV, you must give TDF with other medicines. It is important to take this medicine every day in the recommended dose.

Do not give TDF to women who are less than 18 years old.

Side effects
Diarrhea, nausea, vomiting, headaches, weakness.
Warning
Tenofovir can cause kidney problems. Seek care immediately if the person has signs of kidney failure.


Pregnant women need to take special care

Breastfeeding women need to take special care

WARNING!
zidovudine  (ZDV, AZT)

Zidovudine is used in combination with other medicines to treat HIV, and to prevent passing HIV to a baby.

Often comes in:
Tablets: 300 mg
Capsules: 100 mg, 250 mg
Oral solution or syrup: 50 mg per 5 ml
Liquid for injection: 10 mg per ml in 20 ml vial.
How to use:
For HIV, give 250 to 300 mg 2 times a day, along with other medicines.

To prevent HIV from passing to a baby during birth: For the mother, give 300 mg, 2 times a day, every day, starting at 14 weeks of pregnancy. At the beginning of labor, give the mother 600 mg, one time only.

If she is breasfeeding her baby, give the mother 300 mg 2 times a day for 7 days, along with 3TC.

For a baby born to a woman with HIV who is not breastfeeding, give 4 mg oral solution for each kilogram of weight (12 mg for a 3 kg baby), by mouth, 2 times a day for 6 weeks. You should also give nevirapine.
Information you
should know
To treat HIV, you must give AZT with other medicines. It is important to take this medicine every day, in the recommended dose.
Side effects
Diarrhea, nausea, belly pain, vomiting. These effects usually get somewhat better after a few weeks.

Seek care immediately for pale skin or other signs of anemia.
Warning
AZT can cause severe anemia. If testing is available, check the woman’s hemoglobin before starting AZT, and regularly while she uses it, especially if you live where there is a lot of malaria.

Do not give AZT with stavudine (d4T).

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