Entering HIV Treatment
Each HIV infected patient who is entering into care should have a full medical history, physical, lab evaluation and counseling. This is to confirm the presenence of HIV, get historical and laboratory data, discuss treatment of HIV with patient, and initiate care as suggested by HIV primary care guidelines. Baseline information then is used to define management goals and plans.
A new patient should have the following tests performed on them in their first visits
• HIV antibody testing (if prior documentation not available) or if HIV RNA is undetectable (AI);
– CD4 + cell count
– HIV RNA (Viral Load);
• Complete blood count, chemistry profile, transaminase levels, BUN and creatinine, urinalysis, screening test
for syphilis (e.g., RPR, VDRL, or treponema EIA), tuberculin skin test (TST) or interferon-γ release assay
IGRA (unless there is history of a prior TB or positive TST or IGRA), anti Toxoplasma gondii IgG,
hepatitis A, B, and C serologies, and Pap smear in women;
– Fasting blood glucose and serum lipids if the person is considered to be at risk for heart disease and for
baseline evaluation before the start of ARV therapy and
• For patients who have pretreatment HIV RNA >1,000 copies/mL, genotypic resistance testing when the
regardless of whether or not a patient is going to begin therapy immediately they need to enter into care. For patients who
have HIV RNA levels of 500–1,000 copies/mL, resistance testing also may be considered, even though
amplification may not always be successful (BII). If therapy is deferred, repeat testing at the time of
antiretroviral initiation should be considered (CIII).
Patients living with HIV infection must often cope with multiple social, psychiatric, and medical issues that are best
addressed through a multidisciplinary approach to the disease. The evaluation also must include assessment of
substance abuse, economic factors (e.g., unstable housing), social support, mental illness, comorbidities, high-risk behaviors, and other factors that are known to impair the ability to adhere to treatment and to promote education about HIV Once evaluated, these factors should be managed accordingly.
Lastly, risk behaviors and effective strategies to prevent HIV transmission. to others should be
provided at all a patient’s clinical visits.
Tags: AIDS, HIV, HIV Treatment
