# HIV Management

> HIV management for FMGE: NACO testing strategy, TLD first-line ART, viral load monitoring, opportunistic infections and PMTCT in Indian practice.

- Canonical URL: https://prepelephant.com/topics/fmge/medicine/hiv-management-naco
- Exam / course: FMGE · Subject: Medicine
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "HIV Management", PrepElephant, https://prepelephant.com/topics/fmge/medicine/hiv-management-naco

## Direct answer

Under the National AIDS Control Programme, India manages HIV with test-and-treat: antiretroviral therapy for everyone diagnosed, regardless of CD4 count, free of cost through NACO centres. The preferred first-line regimen since 2020 is the single-tablet combination TLD — tenofovir, lamivudine and dolutegravir — with viral load checked at six months after initiation and then yearly. Tuberculosis remains the commonest opportunistic infection in Indian patients, and prevention of parent-to-child transmission gives every pregnant woman lifelong triple therapy.

## What you must remember

- Diagnosis follows the national three-test algorithm using rapid antibody or antigen tests at an Integrated Counselling and Testing Centre; a reactive screening test is confirmed by two different assays before a positive report is issued.
- First-line antiretroviral therapy in adults and adolescents is a once-daily fixed-dose TLD tablet — tenofovir disoproxil fumarate, lamivudine and the integrase inhibitor dolutegravir — chosen for potency, tolerability and its high barrier to resistance.
- Treatment is lifelong, started on the day of confirmation; the CD4 count guides opportunistic-infection prophylaxis and follow-up, while the viral load at six months and then annually confirms suppression.
- Cotrimoxazole preventive therapy is given with advanced or symptomatic disease (broadly, CD4 below 350 cells per microlitre or WHO clinical stage 3 or 4), protecting against Pneumocystis pneumonia and toxoplasmosis.
- Tuberculosis is the leading opportunistic infection and killer of people living with HIV in India; screen at every visit, and co-infected patients receive antitubercular therapy with antiretroviral therapy, with timing guided by severity and immune status.
- Immune reconstitution inflammatory syndrome may worsen symptoms weeks after therapy starts — it is managed with corticosteroids in significant cases, not by stopping antiretrovirals.
- Prevention of parent-to-child transmission: pregnant women take lifelong triple therapy, babies receive six weeks of nevirapine, and early infant diagnosis uses DNA PCR at around six weeks.

## Common confusion

Candidates trained abroad often answer efavirenz-based regimens, which India has moved away from in favour of dolutegravir-based TLD, or recall CD4 thresholds for starting therapy that the test-and-treat era abolished — therapy starts at diagnosis. A second confusion is between treatment failure (persistent detectable viral load after six months with adherence addressed), which triggers a switch to a second-line protease-inhibitor-based regimen, and immune reconstitution inflammatory syndrome, which occurs despite good viral response. Remember also that HIV reporting is coded and voluntary in counselling terms, but notification to the public health system applies.

## Exam-focused takeaway

FMGE HIV questions are algorithm questions: the exposure or positive screening test routes to the national three-test algorithm, the newly diagnosed patient starts TLD immediately under test-and-treat, and the six-month viral load judges success. Learn the India-specific pairs — tuberculosis as the opportunistic infection, cotrimoxazole as the prophylaxis, nevirapine for the exposed neonate — and the dolutegravir switch from efavirenz. Expect a stem on immune reconstitution inflammatory syndrome after therapy initiation, where the answer is continue antiretrovirals and treat the inflammatory component.

## Frequently asked questions

### What is the first-line ART regimen in India?

TLD — tenofovir, lamivudine and dolutegravir, once daily — NACO's first line for adults and adolescents since 2020.

### When is antiretroviral therapy started?

At diagnosis, under the test-and-treat policy, irrespective of CD4 count or clinical stage.

### What is the commonest opportunistic infection in Indian patients with HIV?

Tuberculosis, which must be actively sought at every visit and treated alongside antiretroviral therapy when found.

### What prophylaxis does the HIV-exposed newborn receive?

Nevirapine prophylaxis (six weeks as standard) alongside safe infant feeding, with early infant diagnosis by DNA PCR at around six weeks of age.

### What is immune reconstitution inflammatory syndrome?

A paradoxical worsening of opportunistic infections or their residues weeks after starting therapy, as immunity recovers; significant cases receive corticosteroids while antiretrovirals continue.