Lesotho to revise national guidelines to include tenofovir first line

The most important changes in the revised Lesotho national ART guidelines will be:

  • CD4 threshold for initiation of HAART will change from < 200 to < 350 cells/mm3
  • First-line will change from d4T/3TC/nevirapine (or efavirenz) to tenofovir/3TC/EFV (or NVP), so that the regimens in order of “preference” will be:
    1. TDF/3TC/EFV (except for women of child-bearing age not on reliable contraception, children, and people with pre-existing renal dysfunction)
    2. TDF/3TC/NVP
    3. AZT/3TC/EFV
    4. AZT/3TC/NVP
    5. d4T/3TC/EFV
    6. d4T/3TC/NVP
  • PMTCT protocol will officially change from sd NVP to HAART for all pregnant women < 350 (AZT/3TC/NVP for < 250 and AZT/3TC/EFV for 250-350 after 1st trimester) and short-course AZT from 28 weeks (plus sd NVP and AZT 600mg at onset of labour + tail protection for the mother + PEP for the baby, etc.) for those > 350 cells/mm3.

The revised guidelines are still in draft form but have been provisionally approved by the Director General of Health at the Ministry of Health and Social Welfare (MOHSW) and are awaiting final approval.


This will be the first country in Africa to include TDF first line. The PMTCT recommendations are also very good news. Viva Lesotho for being so progressive (and the Ministry of Health of their more affluent, landlocking neighbours take note).

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