6.5. What is Combination Therapy?

There are many different ARV drugs but none work well on their own. They work best when you take 3 ARVs together. This is called combination therapy. The combination (mix) you are given will control the amount of HIV in your body by stopping it from increasing.
Guidelines have been developed in South Africa to help doctors, nurses and other health workers and you to decide if and when to put you on ARVs. There are many different HIV drugs and the Guidelines outline what combinations of ARVs are recommended to start with. Currently there are 2 combinations available in South African public health facilities. A doctor will decide which combination is best for you.
First line therapy
The first combination of medicines you take is called 1st line treatment. In South Africa these are either:
1. Stavudine (d4T) (or Zidovudine: AZT or Abacavir or tenofovir) and Lamivudine (3TC) and Nevirapine (NVP)
OR
2. Stavudine (d4T) (or Zidovudine: AZT or Abacavir or tenofovir) and Lamivudine (3TC) and Efavirenz
Most people start with one of these 2 combinations. If this combination gives you bad side effects, or if it stops working well, your doctor may decide to change your medicines.
HIV positive pregnant women should be treated with either Nevirapine and/or AZT. The treatment that is prescribed for you will depend on a number of different factors. It is important to note that whichever treatment you are offered, you will be protected from passing the HIV virus to your unborn baby. You will be given either Nevirapine and/or AZT when you start labour to prevent the transmission of HIV to your baby. Your baby should also be given a small amount of Nevirapine within 3 days of the birth. Babies take it in syrup form so it is easy for them to swallow.
Second line therapy
If the 1st line treatment is not working, your doctor may try a different combination.
This is called 2nd line treatment. In South Africa these are either:
1. Zidovudine (AZT) and Didanosine (ddI) and Lopinovir (LPV)
OR
2. Zidovudine (AZT) and Didanosine (ddI) and Ritonavir (r).
Other combinations of drugs may also be used in some cases.


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