HIV Clinical Pathway Hub

Integrated Decision Support for HIV Care · NACO 2021 / WHO 2021 · v1.7
How to use this tool: Enter the demographics once. Every pathway module in this group will read them from your browser session. You can also arrive here from any of those modules, and your entries persist.
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.
1. 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%
2. 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: 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)
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. 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. DRV/r becomes the preferred boosted PI; supports reuse of TDF and ABC in subsequent regimens; long-acting injectable ART and oral two-drug regimens in defined circumstances; revised vertical transmission and TB preventive treatment guidance. NACO remains the operative source for Indian practice.]
  5. 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.
  6. NACO. National Guidelines for Prevention of Parent-to-Child Transmission of HIV. 2021.
  7. 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 and scope
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 & Management PathwaysPathway
Specialties Internal Medicine, Infectious Diseases, HIV Medicine
Status Essential
Written and maintained by Dr Shashikiran Umakanth.
Last revised: 8 August 2026
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First-Line ART SelectionART Monitoring & ADR GuideSecond-Line ART PathwayOI Prophylaxis Pathway
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