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Table 4. Recommended Initial Laboratory Screening and
Other Studies in Persons with HIV
Test Comment(s)
HIV-specific Tests for All Persons with HIV
HIV antigen/antibody testing If written evidence of diagnosis not available or if
viral load low or undetectable.
CD4 cell count and percentage Assess need for opportunistic infection (OI)
prophylaxis.
Plasma HIV RNA PCR (HIV
viral load)
Establish baseline and monitor viral suppression.
HIV resistance testing Baseline genotype for PI, NNRTI, NRTI
mutations for persons who have never initiated
therapy or who are reengaging in care and not on
therapy or with inconsistent access to therapy.
INSTI genotype is recommended only if suspicion
for INSTI mutation transmission.
HIV-related Tests in Selected Patients
Coreceptor tropism assay If use of CCR5 antagonist is being considered.
HLA B*5701 If use of abacavir is being considered.
Other Laboratory Tests
Complete blood cell count with
differential
Assess for anemia, neutropenia,
thrombocytopenia.
Alanine aminotransferase,
aspartate aminotransferase, total
bilirubin, alkaline phosphatase
Assess for evidence of liver damage, hepatitis,
or systemic infection (e.g., elevated alkaline
phosphatase with some OIs).
Total protein and albumin High total protein common with untreated HIV
infection due to increased immunoglobulin
fraction secondary to B-cell hyperplasia. Low
albumin may indicate nutritional deficiency or
nephrotic syndrome.
Electrolytes, blood urea nitrogen,
creatinine
Assess kidney function: Use creatinine to calculate
estimated GFR.
Lipid profile and blood glucose;
hemoglobin A1c
Fasting not needed for initial lipid and glucose
assessment. If abnormal, repeat fasting.
Hemoglobin A1c should be measured prior to
ART initiation but is not used for diagnosis of
diabetes in those on ART.
Urinalysis Assess for evidence of proteinuria, hematuria.
