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Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents

Baseline Evaluation

(Last updated:1/10/2011; last reviewed:1/10/2011)

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Each HIV-infected patient entering into care should have a complete medical history, physical examination, and laboratory evaluation and should be counseled regarding the implications of HIV infection. The goals of the initial evaluation are to confirm the presence of HIV infection, obtain appropriate baseline historical and laboratory data, ensure patient understanding about HIV infection and its transmission, and initiate care as recommended by established guidances such as the HIV primary care guidelines [1] and the guidelines for prevention and treatment of HIV-associated opportunistic infections [2]. Baseline information can then be used to define management goals and plans.

The following laboratory tests performed during initial patient visits can be used to stage HIV disease and to assist in the selection of antiretroviral (ARV) drug regimens:

  • HIV antibody testing (if prior documentation is not available or if HIV RNA is below the assay’s limit of detection) (AI);
  • CD4 T-cell count (AI);
  • Plasma HIV RNA (viral load) (AI);
  • Complete blood count, chemistry profile, transaminase levels, blood urea nitrogen (BUN) and creatinine, urinalysis, and serologies for hepatitis A, B, and C viruses (AIII);
  • Fasting blood glucose and serum lipids (AIII); and
  • Genotypic resistance testing at entry into care, regardless of whether ART will be initiated immediately (AIII). For patients who have HIV RNA levels <500–1,000 copies/mL, amplification of virus for resistance testing may not always be successful (BII).
In addition, other tests, including screening tests for sexually transmitted infections and tests for determining risk of opportunistic infections and need for prophylaxis, should be performed as recommended by HIV primary care and opportunistic infections guidelines [1-2].

Patients living with HIV infection must often cope with multiple social, psychiatric, and medical issues that are best addressed through a patient-centered, multidisciplinary approach to the disease. The evaluation also must include assessment of high-risk behaviors, substance abuse, social support, mental illness, comorbidities, economic factors (e.g., unstable housing), medical insurance status and adequancy of coverage, and other factors that are known to impair adherence to treatment and to increase the risk of HIV transmission. Once evaluated, these factors should be managed accordingly.

Education about HIV risk behaviors and effective strategies to prevent HIV transmission should be provided at each patient visit. (See Preventing Secondary Transmission of HIV.)

References

  1. Aberg JA, Kaplan JE, Libman H, et al. Primary care guidelines for the management of persons infected with human immunodeficiency virus: 2009 update by the HIV medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2009;49(5):651-681.
  2. Centers for Disease Control and Prevention (CDC). Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. 2009;58(RR-4):1-207.