ART regimens in children are age- and weight-dependent. As children grow, their doses and regimens need to be adjusted. For example, a child started at age 2 on ABC + 3TC + LPV/r will transition to ABC + 3TC + EFV once they are older than 3 years and weigh more than 15 kg.
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Adults and Adolescents (Aged 10 years and older or >35 kg)
| Indication | Recommended Regimen |
|---|---|
| Starting ART | TDF + 3TC + EFV |
| If EFV is contraindicated | TDF + 3TC + NVP (2014 guidelines) |
| If TDF is contraindicated | AZT + 3TC + EFVAZT + 3TC + NVP (2014 guidelines) |
Pregnant and Breastfeeding Women
| Indication | Recommended Regimen |
|---|---|
| Starting ART while pregnant or breastfeeding | TDF + 3TC + EFV |
| If TDF and/or EFV are contraindicated | ABC + 3TC + ATV/r |
Children Aged 3 to Less Than 10 Years (or Weighing Less Than 35 kg)
| Indication | Recommended Regimen |
|---|---|
| Starting ART | ABC + 3TC + EFV |
| If EFV is contraindicated | (See below for DTG/NVP options) |
Children Under 3 Years of Age (or Weighing Less Than 15 kg)
| Indication | Recommended Regimen |
|---|---|
| Starting ART | ABC + 3TC + DTG (2020 guidelines) |
| If unable to use LPV/r | ABC + 3TC + NVP |
Notes
- TDF + 3TC + EFV is the preferred first-line regimen for adults because it:
- Has low toxicity
- Is taken once daily
- Also works against hepatitis B
- Is cost-effective
- Does not cause anaemia (unlike AZT, which is better reserved for second-line regimens)
- Contraindications for EFV:
- Severe depression or psychosis
- Concurrent use of benzodiazepines or carbamazepine
- Neurological disease that interferes with side-effect assessment
- Age under 3 years or weight under 15 kg
- Contraindications for TDF:
- Kidney disease or GFR below 60
- Adolescents weighing less than 35 kg
- Children unable to swallow LPV/r pellets can start with nevirapine and switch to LPV/r when able.
Triple NRTI regimens are no longer recommended due to poor viral suppression and limited future treatment options.
Important Drug Interactions
- Oral contraceptives: Metabolised more quickly by EFV and NVP — additional barrier methods are recommended.
- Injectable progesterone-only methods and IUDs: No major interactions; safe to use.
- Levonorgestrel implants: Effectiveness reduced by EFV and NVP — add barrier protection.
- Emergency contraception: Double the standard dose if patient is on EFV or NVP.
- Rifampicin: Increases metabolism of PIs and nevirapine — refer to TB-HIV co-treatment guidance.
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