Table 6. Laboratory Monitoring for Patients Prior to and After
Initiation of Antiretroviral Therapy
Entry Into
Care
Follow-up
Before ART
ART
Initiation or
Modification
1
2–8 Weeks
Post-ART
Every
3–6 Months
Every
6 Months
Every
12 Months
Treatment
Failure
Clinically
Indicated
CD4 T-cell count
✔
q3–6 mo
✔
✔
2
In clinically stable patients with
suppressed viral load, CD4 count
can be monitored every 6–12 mo
✔ ✔
HIV RNA
✔
q3–6 mo
✔
✔
2
✔
3
✔ ✔
Resistance testing
✔
✔
4
✔ ✔
HLA-B*5701
testing
✔
If considering
ABC
Tropism testing ✔
If considering a
CCR5 antagonist
✔
If considering a
CCR5 antagonist
or for failure of
CCR5 antagonist-
based regimen
✔
Hepatitis B
serolog y
5
✔
✔
May repeat if
HBsAg (−) and
HBsAb (−) at
baseline
✔
Basic chemistry
6
✔
q6–12 mo
✔ ✔ ✔ ✔
ALT, AST, T bili,
D bili
✔
q6–12 mo
✔ ✔ ✔ ✔
CBC w/
differential
✔
q3–6 mo
✔
✔
If on ZDV
✔ ✔
Fasting lipid
profile
✔
If normal,
annually
✔
✔
Consider 4–8
weeks after
starting new
ART
✔
If abnormal
at last
measurement
✔
If normal at last
measurement
✔
Fasting glucose
✔
If normal,
annually
✔
✔
If abnormal
at last
measurement
✔
If normal at last
measurement
✔
Urinalysis
7
✔ ✔
✔
If on TDF
8
✔ ✔
Pregnancy test ✔
If starting EFV
✔
1
ARV modification may be done for treatment failure, adverse effects, or simplification.
2
If HIV RNA is detectable at 2–8 weeks, repeat every 4–8 weeks until suppression to <200 copies/mL,
then every 3–6 months.
3
For adherent patients with suppressed viral load and stable clinical and immunologic status for
>2–3 years, some experts may extend the interval for HIV RNA monitoring to every 6 months.
4
For ART-naive patients, if resistance testing was performed at entry into care, repeat testing is
optional; for patients with viral suppression who are switching therapy for toxicity or convenience,
resistance testing will not be possible and therefore is not necessary.
5
If HBsAg is positive at baseline or prior to initiation of ART, TDF + (FTC or 3TC) should be
used as part of ARV regimen to treat both HBV and HIV infections. If HBsAg and HBsAb are
negative at baseline, hepatitis B vaccine series should be administered.
6
Serum Na, K, HCO
3
, Cl, BUN, creatinine, glucose (preferably fasting ); some experts suggest
monitoring phosphorus while on TDF; determination of renal function should include estimation
of CrCl using the Cockcroft-Gault equation or estimation of glomerular filtration rate based on the
Modification of Diet in Renal Disease equation.
7
For patients with renal disease, consult "Guidelines for the Management of Chronic Kidney Disease
in HIV-Infected Patients: Recommendations of the HIV Medicine Association of the Infectious
Diseases Society of America."
8
More frequent monitoring may be indicated for patients with increased risk of renal insufficiency,
such as patients with diabetes, hypertension, etc.
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