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HIV Primary Care

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Figure 1. Primary Care Management of HIV Screening Rapid HIV or ELISA + Confirm with Western blot or IFA Initial Evaluation • History and physical examination • CD4 count • HIV serolog y • HIV RNA (viral load) • HIV genotype • CBC, chem panel • Fasting lipids • Urinalysis, CrCl • HBsAg, HBsAb, anti-HBc (HBcAb) • HCV antibody • Anti-CMV IgG • Syphilis • Gonorrhea • Chlamydia Other Tests • Resistance —for virologic failure • Coreceptor tropism—if considering CCR5 antagonist • G6PD if at risk • HLA B*5701 before initiating abacavir • TB • Toxoplasma gondii • HBV DNA if HBsAg−, HBsAb−, and anti-HBc+ • HCV RNA if HCV antibody+ • Trichomoniasis if female • Pap smear if female • HPV if MSM, Pap+, or genital warts • Testosterone if symptomatic • CXR if TB+ Initial Prevention of Secondary Infections • HBV vaccination • HAV vaccination if susceptible • Varicella vaccination if age >8 y and CD4 cells >200/μL, or 1–8 y and CD4 cell percentage >15% • VariZIG within 10 days if exposed to VZV and susceptible • HPV vaccination if female 9–26 y • Pneumococcal vaccination Key Points

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