The government of India established the National AIDS Committee in 1986, which set the foundation for the establishment of National AIDS Control Organization (NACO) in 1992 to oversee the policies for prevention and control of HIV.

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These guidelines aim:

  • To harmonize treatment practices between the public and the private sector since there are patients who seek care from both the sectors at the same time or at different points in time.
  • To consolidate various existing guidelines and incorporate recommendations for all age groups, gender, and populations
  • To provide standardized guidelines for prophylaxis, prevention, screening, diagnosis and management of common opportunistic infections among PLHIV

These guidelines continue to evolve and are revised and updated on regular basis as per national and global evidence and recommendations. 

This blog will familiarize you of the latest NACO Guidelines (October 2018) for HIV.

Salient Points of NACO-October 2018 Guidelines

1.       When to start ART:

In all patients irrespective of CD4 count or symptoms

2.       First Line ART:  

a)      Adults and adolescents

T+ L +E

b)      Children A+ L+E
c)       Any person with weight less than 30Kg A+ L+E
d)      If elevated serum creatinine A+ L+E
e)      Infection with HIV-2 (or HIV-1 + HIV-2) T+ L +L/r

3.       ART in pregnancy and breastfeeding

a)      ART-native female  T+ L +E
b)      Already on ART Continue same

c)       Exposure too nevirapine alone in prior pregnancy

T+ L +L/r

4.       Infant prophylaxis:  

a)       Mother taking ART for ≥ 4 weeks

N for 6 weeks
b)      Mother taken ART for < 4 weeks N for 12 weeks
c)       Mother exposed to nevirapine previously Z for 6/12 weeks

5.       Post-exposure Prophylaxis:

T+ L +L/r

 

Special Points to Remember:

1. First line regimen is TLE

2.A should be used in place of T in:

  • Children
  • If weight is less than 30 Kg
  • Renal disease

3. NNRTI are not effective in HIV-2, so L/r should be used.

4. Resistance develops quickly to monotherapy of NNRTI like N, therefore, L/r should be used if

  • Prior exposure to nevirapine alone
  • In post-exposure prophylaxis

 

Abbreviations used:

T: Tenofovir

L: Lamivudine

E: Efavirenz

A: Abacavir

L/r: Lopinavir + Ritonavir

N: Nevirapine

For the detailed document on latest NACO Guidelines for HIV- Click Here

 

Stay tuned for more updates..

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