HIV Clinical Pathway Hub Integrated Decision Support for HIV Care · NACO 2021 / WHO 2021 · v1.0
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Patient Demographics & Baseline
Clinical Parameters
⚙ Clinical Pathway Modules
⚙ WHO Clinical Staging at a Glance
Stage Defining Conditions Action
1 Asymptomatic, persistent generalised lymphadenopathy Start ART. No OI prophylaxis required if CD4 > 200.
2 Moderate weight loss (< 10%), recurrent URTIs, herpes zoster, angular cheilitis Start ART. Consider OI prophylaxis based on CD4.
3 Severe weight loss (> 10%), chronic diarrhoea > 1 month, pulmonary TB, oral candidiasis AHD protocol. Start Cotrimoxazole. Screen OIs before ART.
4 HIV wasting, PCP, Cryptococcal meningitis, Kaposi sarcoma, extrapulmonary TB, CMV retinitis AHD protocol. Treat OIs first. Delay ART per OI-specific timelines.
NACO First-Line ART: Quick Reference
Clinical Scenario Preferred Regimen Key Consideration
Standard adult (CrCl ≥ 50) TLd (TDF + 3TC + DTG) One pill, once daily FDC
Renal impairment (CrCl < 50), Hb ≥ 8 AZT + 3TC + DTG Monitor CBC at 4 wks, 3 months
Renal impairment + Anaemia (Hb < 8) ABC + 3TC + DTG HLA-B*5701 testing; watch for HSR
Active TB on Rifampicin Base regimen + DTG 50mg BD Extra DTG dose for 2 wks post-Rif
HBV coinfection TDF-containing regimen preferred Never interrupt TDF/3TC abruptly
Pregnancy TLd (DTG safe per WHO/NACO) Folic acid 5mg daily; NTD risk ~0.19%
NACO Second-Line ART: Quick Reference
Failed First-Line Second-Line Regimen Key Point
TDF + 3TC + DTG AZT + 3TC + ATV/r (or LPV/r) Switch NRTI backbone; add boosted PI
AZT + 3TC + DTG (or NVP/EFV) TDF + 3TC + ATV/r (or LPV/r) Switch NRTI backbone; add boosted PI
ABC + 3TC + DTG AZT or TDF + 3TC + ATV/r (per CrCl/Hb) Base selection on current renal and Hb status
Abbreviations: ART (Antiretroviral Therapy) · TDF (Tenofovir Disoproxil Fumarate) · TAF (Tenofovir Alafenamide) · 3TC (Lamivudine) · DTG (Dolutegravir) · AZT (Zidovudine) · ABC (Abacavir) · EFV (Efavirenz) · NVP (Nevirapine) · ATV/r (Atazanavir/Ritonavir) · LPV/r (Lopinavir/Ritonavir) · DRV/r (Darunavir/Ritonavir) · CrCl (Creatinine Clearance) · AHD (Advanced HIV Disease) · OI (Opportunistic Infection) · PMTCT (Prevention of Mother-to-Child Transmission) · PI (Protease Inhibitor) · INSTI (Integrase Strand Transfer Inhibitor)
Algorithm References & Evidence Base
  1. National AIDS Control Organisation (NACO). National Guidelines for HIV Care and Treatment. MoHFW, Government of India; 2021.
  2. NACO. National Technical Guidelines on Anti-Retroviral Treatment. October 2018 (Updated 2021).
  3. World Health Organization. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring. 2021.
  4. Venter WDF, Moorhouse M, et al. Dolutegravir plus two different prodrugs of tenofovir to treat HIV. N Engl J Med. 2019;381(9):803-815.
  5. NACO. National Guidelines for Prevention of Parent-to-Child Transmission of HIV. 2021.
  6. WHO. Guidelines on post-exposure prophylaxis for HIV and the use of cotrimoxazole prophylaxis for HIV-related infections among adults, adolescents and children. 2014 (updated 2021).
How to Cite This Tool

AMA Style: Umakanth S. HIV Clinical Pathway Hub. MEDiscuss. Published 2026. Accessed .

Vancouver Style: Umakanth S. HIV Clinical Pathway Hub [Internet]. MEDiscuss.org; 2026 [cited ]. Available from:

⚠ Disclaimer: This decision-support system is intended for healthcare professionals. It does not substitute clinical judgment. These algorithms are evidence-based, but medical knowledge evolves continuously. The treating physician retains absolute responsibility for all diagnostic, dosing, and therapeutic decisions. Always verify outputs against current institutional protocols and individual patient contexts.
© 2026 MEDiscuss.org. All rights reserved. This CDSS Module was designed and developed by
Dr. Shashikiran Umakanth using the available evidence base. Provided free of charge for clinical use. Unauthorised reproduction or redistribution is strictly prohibited.
Category Therapeutic Pathways & Algorithms
Specialties Internal Medicine, Infectious Diseases, HIV Medicine
Status New Pathway
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NACO First-Line ART Initiation PathwayNACO Second-Line ART PathwayNACO PMTCT Pathway
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