Always consider using presumptive (also known as empiric) treatment in seriously ill adults. Empiric treatment may be an option especially in very ill patients (eg. presumptive TB) may require the start of ant-TB therapy to avoid delay. A therapeutic challenge may need to be considered in severely ill patients.
Treatment care guidelines and references
- Always keep a copy of the latest treatment guidelines on your work desk. It is unreasonable to expect healthcare worker to remember all the lists, medicine doses and algorithmic approaches
- Ensure you have an updated copy
- Electronic copies are now also readily available to most information sources. Use your smartphone (including mobile Apps) or computer to access
- Attach information guideline posters to the walls in your examination room as a job aid
- Keep a list of important and up to date list of contact telephone numbers for your network eg. laboratory. This may also assist any staff in your absence.
- Keep stock of all stationary required for patient care, e.g., X-ray forms
CD4 recovery
Patients who present with very low CD4 counts may have been HIV-positive for many years. Recovery of immune status after initiating ART is slow, and may take many months. On average, expect CD4 count to recover slowly, and rise by 80 -100 cells per year. CD4 counts continued to rise even up to 10 years after ART initiation, with the steepest increase in the first 3 months. Furthermore, the quality of new CD4 cells may be compromised if the starting CD4 nadir (lowest/starting point) was very low. In South Africa, reductions in the numbers of people with CD4 counts <100 or < 200 have stalled, with over 30% of people seeking care having AHD, and over 15% have CD4 counts <100.
The greatest increase in CD4 count (steepest rise) usually occurs in the first 3 – 8 months; then there is a slowing down of recovery.

The National HIV & TB Health Care Worker (HCW) Hotline is a toll-free hotline that provides information to health care workers in South Africa on all aspects concerning the treatment of HIV and TB.
For details on drug-drug interactions, call the HIV & TB HOTLINE 0800 212 506 or download the app for free.