Treatment Guidelines

Nutritional Counseling

HIV infection is often related to poor nutrition. This is due to many factors, including increased energy needs, decreased appetite, and environmental factors such as lack of resources and inaccessibility of foods. In addition, symptoms of HIV opportunistic infections also lead to difficulty in swallowing and poor absorption. Therefore, proper nutrition is important for people living with HIV. Patients with HIV should have access to nutritional support.

Treatment Guidelines

The 2013 World Health Organization (WHO) Consolidated Guidelines of the use of antiretroviral drugs for treating and preventing HIV infections provide new guidelines on the diagnosis of HIV, the care of People living with HIV and the use of antiretroviral drugs for treating and preventing HIV infection.


The 2013 guidelines also combine recommendation across the continuum of HIV care, HIV testing and counselling, using ARV drugs for prevention, linking individuals to HIV treatment and care services, providing general HIV care, Initially and maintaining ART and monitoring treatment. Many of these guidelines and standards are also reflected in Belize’s Guidelines for the clinical Management of HIV/Aids 2012.


There are currently thirteen sited providing antiretroviral therapy for both adults and adolescents in the country. However, because The National Clinical Management guidelines have not been revised since their development in 2003, the clinical management has been largely guided by the Carri bean Guidelines for the Care and Treatment of Persons with HIV Infection (2007). Recognizing the need for revising the national guidelines, this effort is now in effect through the financial support of the Global Fund Project Round 9. Included in this revisited set of guidelines is when to start ART, what to start, adherence and preparation for beginning treatment, the monitoring of patient to identify treatment failure, what ARVs to switch to (second line regimens), treatment for opportunistic infections across all age groups and populations of adults, pregnant and breast-feeding women, adolescents, children and key populations.

When visiting the clinic for the first time, the following processes can be expected:

  • Complete medical history
  • Physical examination, including height, weight BMI, blood pressure, waist circumference
  • Assessment of social and psychological conditions: provisions of support and counseling as needed
  • Consideration of HBV vaccination (depending on serology results) and pneumococcal vaccination
  • History of vaccination, travel and country of origin

Subsequent visits include:

  • Physical examination
  • Physical examination, including height, weight, BMI, blood pressure, waist circumference
  • Evaluation of social and psychological support
  • Healthy lifestyle changes (nutrition, drug use)

Supporting Patients on ART

How well one is doing with upkeep of medication should be examined at every visit in order to identify and correct and possible challenge. A trusting and non-judgmental relationship between the health care provider and the patient is important. Successful strategies that promote adherence in patients who recently started treatment include:

⦿ Establishing Trust

Establishing trust between care provider and care receiver

⦿ Upkeep

Closely monitoring adherence at regular visits

⦿ Advice

Providing opportunities for questions and responding to problems

⦿ The Social treatment

Involving patient’s social contacts to provide continuous support of treatment upkeep

⦿ Medical Supervision
Adding adherence and reinforcements assistance o job descriptions of support team member, such as nurses, pharmacists, case managers, and clinicians’ assistants


Why is it important to take ART consistently and properly?

The right treatment can mean that you have a better chance of living a long and healthy life, with almost normal lifespan. Currently available anti-HIV drugs or antiretroviral cannot cure HIV. However, treatment can reduce the amount of HIV in your blood (indicated by viral load tests) to such a low level that it cannot be detected using laboratory tests. This is called and “indetectable” level which is the goal of HIV treatment. Having and undetectable viral load allows the individuals immune system to stay strong and fight off infections. There is evidence that HIV treatment Is effective, when taken properly, and will work against the virus in the long terms keeping the viral load undetectable. However, for this to happen, taking your HIV treatment properly is most important. This is called adherence and it is most important factory under your control in ensuring success of treatment.


Not taking your HIV treatment can mean that the levels of the drugs in your blood are not high enough to properly fight HIV. If this happens, your HIV will be able to reproduce. The strains of HIV that reproduce when you’re taking HIV treatment can develop resistance to the drugs you are taking. Resistance can mean that your HIV treatment will not work properly. Additionally, this could mean that your viral load will increase your CD4 cell count, an important indicator of the health of your immune system, will reduce. Tis situation increases your chances of becoming ill because of HIV.


If your viral load increases to detectable levels, it will be necessary to change your HIV treatment. While there is more choice available now, this new treatment might be more difficult to take than the present regimen you were taking before and could involve a risk of more or new side-effects. There is also a possibility that you could also become resistant to drugs similar to those you are currently taking. This is called cross-resistance and the risk varies between different classes of HIV drugs.


When taken properly, HIV treatment can also lower viral load in genital fluids to undetectable levels. This can reduce the risk of HIV transmission during sex. A consequence of not taking your HIV treatment properly can be that the amount of virus in your genital fluids increases, therefore increasing the risk of passing on HIV to your sexual partner(s) and the type of HIV which you pass on may be resistant to one or more of the drugs.

When to start treatment?

World Health Organization recommends that patients with CD4 counts of 500 cells per millimeter cube could start treatment. Special consideration for the initiation of ant-HIV treatment for those patients with a CD4 count under 500 is made on and individual basis.

What treatment to start?

For qualifying patient who have not taken treatment, a certified clinician or HIV specialists may recommend one of the following regimen:

  • AZT + 3TC + EFV
  • AZT + 3TC +NVP
  • TDF + FTC + EFV
  • TDF + FTC + NVP