HIV Clinical Pathway Hub
Enter the patient once, and move between the five HIV pathways · v1.7- Enter the demographics and baseline values once, and every module in this group reads them from your browser rather than asking again.
- Then open a pathway from the cards below, which starts with those values already filled in.
- The Quick Reference tab holds the WHO staging table and the NACO first-line and second-line regimens.
- The hub itself recommends nothing: it carries the patient context and each module decides.
- What you enter stays in this browser tab and is cleared when the tab closes, so nothing reaches a server and nothing carries over to the next patient.
- Any recommendation of its own. It holds the patient context, and the pathway you open decides.
- Children below 10 years, which the age field does not accept.
- HIV testing and diagnosis, pre-exposure prophylaxis and post-exposure prophylaxis. No pathway card leads to any of them.
- Any record that outlives the browser tab. Nothing is saved to a server, so the values are gone once it closes.
Patient Demographics & Baseline
Clinical Parameters
Clinical Pathway Modules
First-Line ART Initiation
TLd-based regimen selection, NRTI backbone, renal/anaemia adjustments, coinfection modifiers
Start Here
Monitoring, ADR & Substitution
Scheduled monitoring, adverse drug reaction identification, single-drug substitution rules
Virological Failure & Second-Line
Failure criteria, adherence assessment, PI-based second-line regimens, third-line referral
OI Prophylaxis & Prevention
Cotrimoxazole, TB preventive treatment, Fluconazole prophylaxis, and the initiation and stopping rules for each
PMTCT Pathway
Maternal ART, infant prophylaxis, early infant diagnosis (EID), breastfeeding guidance
Cervical Screening in Women Living with HIV
Screening from age 25 rather than 30 and every 3 to 5 years rather than 5 to 10. Invasive cervical cancer is AIDS-defining, so arrange this as part of the initial workup rather than at a later visit
WHO Clinical Staging at a Glance
1. NACO First-Line ART: Quick Reference
2. NACO Second-Line ART: Quick Reference
| Stage | Defining Conditions | Action |
|---|---|---|
| 1 | Asymptomatic, persistent generalised lymphadenopathy | Start ART. No OI prophylaxis required if CD4 ≥ 350. |
| 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 for 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. |
| 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% |
| 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
ABC (Abacavir) · ADR (Adverse Drug Reaction) · AHD (Advanced HIV Disease) · AIDS (Acquired Immunodeficiency Syndrome) · ART (Antiretroviral Therapy) · ATV/r (Atazanavir/Ritonavir) · AZT (Zidovudine) · BD (Twice Daily) · CBC (Complete Blood Count) · CD4 (Cluster of Differentiation 4) · CMV (Cytomegalovirus) · CrAg (Cryptococcal Antigen) · CrCl (Creatinine Clearance) · DRV/r (Darunavir/Ritonavir) · DTG (Dolutegravir) · EFV (Efavirenz) · EID (Early Infant Diagnosis) · FDC (Fixed-Dose Combination) · Hb (Haemoglobin) · HBV (Hepatitis B Virus) · HIV (Human Immunodeficiency Virus) · HLA-B (Human Leucocyte Antigen B) · HSR (Hypersensitivity Reaction) · INSTI (Integrase Strand Transfer Inhibitor) · IPT (Isoniazid Preventive Therapy) · LPV/r (Lopinavir/Ritonavir) · NA (Not Applicable) · NACO (National AIDS Control Organisation) · NRTI (Nucleoside Reverse Transcriptase Inhibitor) · NTD (Neural Tube Defect) · NVP (Nevirapine) · OI (Opportunistic Infection) · PCP (Pneumocystis jirovecii Pneumonia) · PI (Protease Inhibitor) · PMTCT (Prevention of Mother-to-Child Transmission) · Rif (Rifampicin) · TAF (Tenofovir Alafenamide) · TB (Tuberculosis) · TB-LAM (Tuberculosis Lipoarabinomannan Assay) · TDF (Tenofovir Disoproxil Fumarate) · TLd (Tenofovir + Lamivudine + Dolutegravir) · TLE (Tenofovir + Lamivudine + Efavirenz) · TPT (Tuberculosis Preventive Treatment) · URTI (Upper Respiratory Tract Infection) · WHO (World Health Organization) · 3TC (Lamivudine)References
- National AIDS Control Organisation (NACO). National Guidelines for HIV Care and Treatment. MoHFW, Government of India; 2021.
- NACO. National Technical Guidelines on Anti-Retroviral Treatment. October 2018 (Updated 2021).
- World Health Organization. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring. 2021.
- World Health Organization. WHO updated recommendations on HIV clinical management: recommendations for a public health approach. Geneva: WHO; 7 January 2026. [First substantial revision since 2021.
- 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.
- NACO. National Guidelines for Prevention of Parent-to-Child Transmission of HIV. 2021.
- 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
DOIhttps://doi.org/10.5281/zenodo.22401588
AMA Style:Umakanth S. HIV Clinical Pathway Hub. Version 1.7. MEDiscuss Clinical Decision Support System. Published 2026. Accessed . https://mediscuss.org/cdss/hiv-clinical-hub. doi:10.5281/zenodo.22401588
Vancouver Style:Umakanth S. HIV Clinical Pathway Hub [Internet]. Version 1.7. MEDiscuss.org; 2026 [cited ]. Available from: https://mediscuss.org/cdss/hiv-clinical-hub. doi:10.5281/zenodo.22401588
Save this calculation
Whatever you type here stays on this device and is not sent anywhere. The server receives only a scrambled code made from it, so nobody with access to the server can tell which patient a saved calculation belongs to. Enter the same nickname the next time to see that patient's earlier values. What is stored
Category Therapeutic & Management PathwaysPathway
Specialties Internal Medicine, Infectious Diseases, HIV Medicine
Status Essential