Î A comprehensive present and past medical history, physical
examination, medication/social/family history, and review of systems,
including HIV-related information, should be obtained for all patients
upon initiation of care (SR-M).
HIV Disease Tests: Serological Assays for HIV
Î Patients who have no documentation of their HIV serostatus or who
were tested anonymously should have an HIV serologic test performed
upon initiation of care (SR-L).
CD4 Cell Counts and Percentages
Î A CD4 cell count with percentage should be obtained upon initiation of
care (SR-H).
Î Measurement of the CD8 cell count and the ratio of CD4 cells to CD8
cells is unnecessary as the results are not used in clinical decision
making (SR-H).
Plasma HIV RNA Levels
Î A quantitative HIV RNA (viral load) level should be obtained upon
initiation of care (SR-H).
HIV Resistance Testing
Î Because 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 (SR-H). If
therapy is deferred, repeat testing at the time of antiretroviral therapy
(ART) initiation should be considered because of the potential for
superinfection (WR-L).
Î Resistance testing is also indicated for patients who are experiencing
virologic failure, to guide modification of ART (SR-H).
Î In persons failing to respond to integrase strand transfer inhibitor
(INSTI)-based regimens, genotypic testing for INSTI resistance should
be ordered (SR-H).
5
