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Primary Care Guidance for Persons With HIV - 2021

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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.

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