ÎHIV-1 infection should be diagnosed by a rapid HIV test or a conventional
Î
enzyme-linked immunoabsorbent assay (ELISA) and confirmed Western
blot or indirect immunofluorescence assay (IFA) (A-I).
ÎÎA comprehensive present and past medical history, physical
examination, medication/social/family history and review of systems
including HIV-related information, should be obtained in all patients
upon initiation of care (A-III).
ÎProviders should assess the presence of depression, substance abuse,
Î
and domestic violence by means of direct questions or validated
screening tools (A-III).
Serological Assays for HIV
ÎÎPatients who have no documentation of their HIV serostatus or who
were tested anonymously should have an HIV serologic test performed
upon initiation of care (A-III).
CD4+ T-cell Lymphocytes and Percentages
ÎÎA CD4 cell count with percent should be obtained upon initiation of
care (A-I).
ÎÎIt is important that the provider and patient be aware of the
substantial variation in CD4 cell counts especially during acute illness,
and some experts recommend two baseline measurements before
decisions are made to initiate therapy (C-III).
ÎÎMeasurement of the CD8 count and the ratio of CD4 cells to CD8 cells
should not be used in clinical decision making (B-III).
Plasma HIV RNA Levels
ÎÎA quantitative HIV RNA determination (viral load) should be obtained
upon initiation of care (A-I).
HIV Resistance Testing
ÎÎBecause drug-resistant virus can be transmitted from one person
to another, all patients should be assessed for transmitted drug
resistance with an HIV genotype test upon initiation of care (A-III). If
therapy is deferred, repeat testing at the time of antiretroviral therapy
initiation should be considered (C-III).
ÎÎThe results of a baseline resistance assay may be useful in guiding
therapy even if treatment is deferred for many years (B-III).
ÎÎResistance testing is also indicated for patients who are experiencing
virologic failure to guide modification of antiretroviral therapy (A-II).
Complete Blood Count and Chemistry Panel
ÎÎA complete blood count (CBC) with differential count and chemistry
panel should be obtained upon initiation of care (A-III).
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