Begining HIV Treatment
Each HIV-infected patient initially entering into care should have a complete medical history, physical examination, laboratory evaluation, and counseling. The purpose is to confirm the presence of HIV infection, obtain appropriate baseline historical and laboratory data, assure patient understanding about HIV infection, and initiate care as recommended by the HIV primary care guidelines and by the opportunistic treatment and prevention guidelines. Baseline data then is utilized to define management goals and future plans.
The following laboratory tests should be performed for a new patient during initial patient visits:
• HIV antibody testing (if prior documentation not available) or if HIV RNA is undetectable (AI);
- CD4 + cell count
• Plasma HIV RNA (viral load) (AI);
• Complete blood count, chemistry profile, transaminase levels, BUN and creatinine, urinalysis, screening test
for syphilis (e.g., RPR, VDRL, or treponema EIA), tuberculin skin test (TST) or interferon-? release assay
IGRA (unless there is history of a prior TB or positive TST or IGRA), anti Toxoplasma gondii IgG,
hepatitis A, B, and C serologies, and Pap smear in women;
- Fasting blood glucose and serum lipids if the person is considered to be at risk for heart disease and for
baseline evaluation before the start of ARV therapy and
• For patients who have pretreatment HIV RNA >1,000 copies/mL, genotypic resistance testing when the
patient enters into care, regardless of whether therapy will be initiated immediately (AIII). For patients who
have HIV RNA levels of 500–1,000 copies/mL, resistance testing also may be considered, even though
amplification may not always be successful (BII). If therapy is deferred, repeat testing at the time of
antiretroviral initiation should be considered (CIII).
Patients living with HIV infection must often cope with multiple social, psychiatric, and medical issues that are best
addressed through a multidisciplinary approach to the disease. The evaluation also must include assessment of
drug abuse, economic factors (e.g., unstable housing), social support, mental illness, comorbidities, high-risk behaviors, and other factors that are known to impair the ability to adhere to treatment and to promote education about HIV Once evaluated, these factors should be managed accordingly.
Lastly, risk behaviors and effective strategies to prevent HIV transmission. to others should be
provided at each patient clinic visit.