Urinalysis and Calculated Creatinine Clearance
ÎÎA baseline urinalysis and calculated creatinine clearance should be
considered, especially in black HIV-infected patients and those with
advanced disease or co-morbid conditions, because of an increased
risk of nephropathy (B-II).
ÎÎUrinalysis and calculated creatinine clearance should also be
performed prior to starting drugs such as tenofovir or indinavir that
have the potential for nephrotoxicity (B-II).
Fasting Lipid Profile
ÎÎBecause many antiretroviral drugs, HIV infection itself, and host factors
are associated with increased cholesterol and triglyceride levels, a
fasting lipid profile should be obtained upon initiation of care (B-III).
Glucose-6-Phosphate Dehydrogenase (G6PD)
ÎÎQualitative screening for G6PD deficiency is recommended upon entry
into care or before starting therapy with an oxidant drug in patients
with a predisposing racial or ethnic background (B-III).
HLA-B*5701 Screening
ÎÎHLA-B*5701 testing should be performed prior to initiating abacavir
therapy (A-I).
ÎPatients who are positive for the HLA-B*5701 haplotype are at higher risk
Î
for hypersensitivity reactions and should not be treated with abacavir (A-II).
Co-Receptor Tropism Assay
ÎÎTropism testing should be performed prior to the initiation of a CCR5
antagonist antiretroviral drug (A-II).
Tuberculosis Screening
ÎÎUpon initiation of care, HIV-infected patients should be tested for
Mycobacterium tuberculosis infection by either a TST applied on the
volar surface of the forearm by the Mantoux (intradermal injection)
method with an intermediate-strength PPD (0.1 mL containing 5 TU)
or by an interferon gamma release assay (IGRA) (A-I). Those with
positive tests should be treated for latent M. tuberculosis infection
after acute tuberculosis has been excluded.
ÎÎRepeat testing is recommended in patients with advanced HIV disease
who initially had negative TST results but subsequently experienced
an increase in the CD4 count to above 200 cells/mm3 on antiretroviral
therapy and thus may have restored sufficient immunocompetence to
mount a positive reaction (A-III).
ÎÎHIV-infected patients who are close contacts of persons with infectious
tuberculosis should be treated for latent M. tuberculosis infection
regardless of their TST results, age, or prior courses of TB treatment
after the diagnosis of active tuberculosis has been excluded (A-II).
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