8
Diagnosis
III. ROUTINE HEALTHCARE MAINTENANCE
CONSIDERATIONS FOR PEOPLE WITH HIV
HIV-Specific Monitoring Following the Initial Assessment
46. After initiation of ART, HIV RNA should be rechecked after 2–4
weeks but no later than 8 weeks, and then every 4–8 weeks until
suppression is achieved. Afterwards, viral load should be monitored
every 3–4 months to confirm maintenance of suppression below the
limit of assay detection. This interval may be prolonged to every 6
months for adherent patients whose viral load has been suppressed
for more than 2 years and whose clinical and immunologic status is
stable. Viral load should be monitored more frequently after initiation
or change in ART, preferably within 2–4 weeks, with repeat testing
every 4–8 weeks until viral load becomes undetectable.
47. CD4 cell count should be monitored to determine the need for
prophylaxis against opportunistic infections. CD4 cell counts should
generally be monitored every 3–6 months for the first 2 years, or
if the virus is not suppressed. For patients on suppressive ART
regimens with CD4 counts 300–500/µL, CD4 count can be monitored
every 12 months unless there are changes in the patient's clinical
or virologic status. If the CD4 count rises above 500 cells/µL, CD4
monitoring is optional.
Screening for Mental Health and Substance Use Issues
48. Screening for substance use should be done at all healthcare
encounters.
49. Screening for depression using validated screening tools should be
conducted at least annually and as needed.
