Starting ART

Clinical description

• ART does not cure HIV infection.
• ART stops the virus from multiplying, which allows the immune system to recover.
• The virus will ‘wake up’ as soon as ART is interrupted, and it will learn how to evade ART. This

means that ART may no longer work for this patient.

• Once started, ART must be taken every day for life. All patients need effective support:

o Identify a reliable guardian / treatment supporter who needs to attend ART education.

o Link with patient / peer support group

• Successful ART leads to very low levels of virus in blood, semen and vaginal fluids. A suppressed

VL effectively eliminates the risk of sexual or mother-to-child transmission. However, condom use is important o In the first 6 months after starting ART o Later if adherence is not good and/or viral suppression has not been confirmed.

• All patients need a confirmatory HIV test before starting ART (see section 16.3 on page 78) to

rule out any possibility of mix-up of test results or fraudulent access to ART.

• ARVs must not be dispensed outside of certified PMTCT/ART facilities (static or outreach) and

must not be shared, sold or passed on to others.

o Bring back any remaining ARVs at every clinic visit to allow the provider to count them.

o Return unused ARVs (e.g., after a patient’s death) to the clinic for proper disposal.

• Patients who are late for their ART appointment will be actively followed from the clinic (home

visit, phone, guardian).

o Ask for consent for active follow-up at the time of starting ART.

o Patients can withdraw consent at any time.

• A small number of ART patients develop serious side-effects. Educate all patients about the

important signs to look out for (see Key facts for section 16.4.1 on page 80)

Starting ART