14
Selecting a Treatment Regimen
Table 5. Laboratory Monitoring Schedule for HIV-Infected
Patients Before and After Initiation of ART
a
(cont'd)
Laboratory Test
Timepoint/Frequency of Testing
Entry
into
Care
ART
Initiation
b
or
Modification
2–8 Weeks
After ART
Initiation or
Modification
Every 3–6
Months
Hepatitis C
Screening
(HCV antibody
or, if indicated,
HCV RNA)
j
Basic Chemistry
l,m
ALT, AST,
Total bilirubin
CBC with
Differential
If on ZDV
If on ZDV or if
CD4 testing is
done
Fasting Lipid
Profile
n
Fasting Glucose or
Hemoglobin A1C
If abnormal
at last
measurement
Urinalysis
m,o
Pregnancy Test
In women with
child-bearing
potential
a
is table pertains to laboratory tests done to select an ARV regimen and monitor for treatment responses
or ART toxicities. Please refer to the HIV Primary Care guidelines for guidance on other laboratory tests
generally recommended for primary health care maintenance of HIV patients.
b
If ART initiation occurs soon aer HIV diagnosis and entry into care, repeat baseline laboratory testing is
not necessary.
c
ART is indicated for all HIV-infected individuals and should be started as soon as possible. However, if ART
initiation is delayed, patients should be retained in care, with periodic monitoring as noted above.
d
If HIV RNA is detectable at 2–8 weeks, repeat every 4–8 weeks until viral load is suppressed to <200
copies/mL, and thereaer, every 3–6 months.
e
In patients on ART, viral load typically is measured every 3–4 months. However, for adherent patients with
consistently suppressed viral load and stable immunologic status for more than 2 years, monitoring can be
extended to 6-month intervals.
f
Based on current rates of transmitted drug resistance to different ARV medications, standard genotypic drug-
resistance testing in ARV-naive persons should focus on testing for mutations in the reverse transcriptase
and protease genes. If transmitted INSTI resistance is a concern, providers should also test for resistance
mutations to this class of drugs. In ART-naive patients who do not immediately begin ART, repeat testing
before initiation of ART is optional if resistance testing was performed at entry into care. In virologically
suppressed patients who are switching therapy because of toxicity or for convenience, viral amplification will
not be possible. erefore, resistance testing should not be performed. Results from prior resistance testing
can be helpful in constructing a new regimen.
g
If patient has HBV infection (as determined by a positive HBsAg or HBV DNA test), TDF or TAF plus
either FTC or 3TC should be used as part of the ARV regimen to treat both HBV and HIV infections.
h
If HBsAg, HBsAb and HBcAb are negative, hepatitis B vaccine series should be administered. Refer to HIV
Primary Care and Opportunistic Infections guidelines for more detailed recommendations.
