Selecting a Treatment Regimen
Table 6. Laboratory Monitoring for Patients Prior to and After Initiation of Antiretroviral Therapy
Entry into Care
CD4 T-cell count HIV RNA Resistance testing
HLA-B*5701 testing
Tropism testing ✔
✔ ✔
Follow-up Before ART
q3-6mo q3-6mo
Initiation or Modification1
ART ✔ ✔
if considering ABC
✔ 4 ✔
if considering a CCR5 antagonist
✔
Hepatitis B serology5
Basic chemistry6
ALT, AST, T. bili, D. bili
CBC w/ differential
Fasting lipid profile
Fasting glucose Urinalysis7 Pregnancy test ✔
✔ ✔
✔ ✔
q6-12mo q6-12mo
q3-6mo
if normal, annually
✔ ✔
if normal, annually
HBsAg (-) and HBsAb (-) at baseline
may repeat if ✔
✔ ✔
✔ ✔
✔ ✔
consider 4-8 weeks after starting new ART
if on ZDV ✔
✔ ✔ if starting EFV
✔ ✔
1ARV modification may be done for treatment failure, adverse effects, or simplification. 2
3 4 5
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.
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.
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.
For ART-naïve 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.
22 ✔ 2
2-8 Weeks Post-ART
