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  • 1.  ART regimens available in South Africa

    Posted 03-15-2024 12:35

    Hi colleagues! I have a patient new to me originally from South Africa. He's been taking EFV and 3TC/AZT for years with a history of depression and anemia--need to switch his regimen and ideally avoid TDF. 

    The challenge is that he'll be traveling back and forth between the US and South Africa for months at a time and we need to find a regimen that is available in both countries.

    From my research into the Southern African HIV Clinicians Society, the recommended regimen is TDF/3TC and DTG, but we need to avoid TDF given history of renal disease.

    Does anyone know of other ART regimens available in South Africa or can point me to a resource where I can find the answer?


    Paul Sacamano, PhD, MPH, NP-C
    El Rio Health
    Tucson AZ

  • 2.  RE: ART regimens available in South Africa

    Posted 03-15-2024 15:49

    Currently in South Africa, the following ART are available in both public and private sectors:

    TLD (TDF/3TC/DTG 300/300/50 mg) STR

    ALD (ABC/3TC/DTG 600/300/50 mg) STR

    TEE (TDF/FTC/EFV 300/200/600 mg) STR

    TDF/FTC 300/200 mg

    ABC/3TC 600/300 mg

    AZT/3TC 300/150 mg

    LPV/r (200/50 mg)

    ATV/r (300/100 mg)

    Patients in the private sector can access Rilpivirine and TAF but unfortunately not STR.

    I did not list the current third-line regimens (guided by the genotype/resistance that might include DRV/r, ETV and DTG) following PI/r failure mainly acquired through the Department of Health and did not mention pediatric ones.

    Considering that he is travelling that easily, he should if under a good clinician and insurance be able to access TAF if needed


    Dominique Kabengele-Kayembe
    Heidelberg, South Africa

  • 3.  RE: ART regimens available in South Africa

    Posted 03-15-2024 19:45
    What about 3TC/DTG without the TDF? There's no data that it's inferior to 3TC/DTG/TDF.

    Peter Shalit, MD, PhD, FACP, AAHIVS 
    Cabrini Tower, 901 Boren Ave Suite 850, Seattle, WA 98104 
    P 206-624-0688 F 206-624-2432  

  • 4.  RE: ART regimens available in South Africa

    Posted 03-17-2024 09:24

    3TC/DTG is definitely an option even though doesn't appear in national ART and HIV management guidelines provided that the patient HBsAg and eGFR fit the prescribed recs!

    Dominique Kabengele-Kayembe

  • 5.  RE: ART regimens available in South Africa

    Posted 03-16-2024 13:04
    Hi Paul!

    I'll comment as I have a bit of experience within the South African healthcare system. Generally, as with most other African countries, the HIV treatment programmes have the first line as TDF+3TC+DTG, which 95% of patients access free from government-affiliated programmes. TAF-based regimens are also available (particularly TAF+FTC+DTG), but the patient pays out of pocket for them as it is only in the private sector and not in government facilities. I hope this helps!


    Dr. Paul Yonga, MBChB, MSPH, FRCP Edin
    Consultant Infectiologist and Clinical Epidemiologist,
    Infectious Disease and International Health Clinic, CA Medlynks Medical Centre & Laboratory, Nairobi

  • 6.  RE: ART regimens available in South Africa

    Posted 03-17-2024 09:30

    Swiming into SA' ART reality, appropriate ART regimen for this patient cutting through loops and hoops of both SA and US health systems and recs will depend on the patient's "usual" HIV clinician in South Africa, the patient's private cover (insurance), the patient's HBV status and renal status (including TDF nephrotoxicity history or absence).

    Dominique Kabengele-Kayembe