518 Medicines for AIDS
How to take ART
ART is effective only in combinations (regimens) of at least 3 medicines. Some medicines
are combined into 1 or 2 tablets or capsules so there are fewer pills to take. This makes
taking medicines every day easier. The 4 combinations described on the next page are
widely available, have fewer side effects, and are safer. Depending on what is available, other
combinations of medicines may be used where you live.
• Whatever combination you use, take each medicine every day, at the same time of day.
• Twice-a-day medicines should be taken every 12 hours. For example, if you take the first
dose at 6:00 in the morning, then the second dose should be taken at 6:00 in the evening.
Some medicines need to be taken only once a day (see page 476).
Side effects of ART
ART can have side effects. Some side effects decrease and go away completely with
time. Others appear only after you have taken a medicine for a long time. Some common
side effects are bothersome but are not serious, such as diarrhea, tiredness, headaches, and
stomach problems. Talk to your health worker about how to handle these problems. But
keep taking all your medicines until your health worker tells you to change or stop.
Other side effects can be life-threatening, such as severe liver problems, severe tiredness
with shortness of breath, skin allergies and rashes, tingling or burning in the hands and feet,
and anemia. If you have serious side effects, see a health worker right away.
Drug resistance – first and second line combinations
The ART you start on is called a first line combination, or first line regimen. Over a period
of years, HIV can become resistant to ART (see page 481). Many people may need to switch
to a second line of drugs. These are more expensive and less available, but they may be
necessary for some people with HIV to stay alive and healthy. The HIV program where you
get your medicines will have information about which drugs work in your area and if you
need to change.
These recommendations for ART are based on the newest information we have as of 2012.
Changes in drugs: Many people on ART take stavudine (d4T) separately or combined
in a pill called Triomune. Stavudine can cause severe side effects after long‑term use. HIV
treatment programs are moving away from stavudine to use other drugs with fewer side
effects, such as zidovudine and tenofovir. In the meantime, all adults taking stavudine should
only take pills with 30 mg of stavudine. No one should take 40 mg of stavudine, no matter
how much they weigh.
Changes in when to start: People with HIV should start ART early while they are still
healthy to avoid serious illnesses. HIV positive people who are already sick with advanced
AIDS should start treatment, even if no CD4 test is available. To start early, they need a
CD4 test to see if the count is 350 or less.
Changes in who to treat: All pregnant, HIV positive women with a CD4 count of 350
or less should start treatment. ART should also be started for anyone with HIV and active TB
or hepatitis B infection, no matter what their CD4 count is, or whether they have advanced
Where Women Have No Doctor 2012