3
Diagnosis
HIV-Specific Tests for All Persons With HIV
HIV Screening
6. Patients who have no documentation of their HIV status or who were
tested anonymously should have an HIV antigen/antibody screening
test performed upon initiation of care.
CD4 Cell Counts and Percentages
7. A CD4 cell count with percentage should be obtained upon initiation
of care.
8. Measurement of the CD8 cell count and the ratio of CD4 cells to
CD8 cells is unnecessary since the results are not used in clinical
decision-making.
Plasma HIV RNA Levels
9. A quantitative HIV RNA (viral load) level should be obtained upon
initiation of care.
HIV Resistance Testing
10. Patients should be assessed for transmitted drug resistance
with a genotype assay for protease inhibitor (PI), non-nucleoside
reverse transcriptase inhibitor (NNRTI), and nucleoside reverse
transcriptase inhibitor (NRTI) mutations upon initiation of care.
11. Resistance testing should be obtained for patients re-engaging in
care who are currently not on ART or who have not had consistent ART
access, recognizing that absence of resistance mutations does not
guarantee absence of resistance when no selective pressure is present.
12. To guide modification of ART, resistance testing, including for
INSTIs if appropriate, is indicated for patients who are experiencing
virologic failure and should be performed while on the failing ART
regimen or within 4 weeks of discontinuing the ART regimen.
13. If transmitted integrase strand transfer inhibitor (INSTI) resistance is
suspected, genotypic testing for INSTI resistance should be obtained.
