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
