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Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV

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Laboratory Testing

Laboratory Testing for Initial Assessment and Monitoring of Patients with HIV Receiving Antiretroviral Therapy

Last Updated: October 17, 2017; Last Reviewed: October 17, 2017

Several laboratory tests are important for initial evaluation of patients with HIV upon entry into care, and before and after initiation or modification of antiretroviral therapy (ART) to assess the virologic and immunologic efficacy of ART and to monitor for laboratory abnormalities that may be associated with antiretroviral (ARV) drugs. Table 3 outlines the Panel on Antiretroviral Guidelines for Adults and Adolescents (the Panel)’s recommendations on the frequency of testing. As noted in the table, some tests may be repeated more frequently if clinically indicated.

Two surrogate markers are routinely used to monitor patients with HIV: CD4 T lymphocyte (CD4) cell count to assess immune function and plasma HIV RNA (viral load) to assess level of HIV viremia. Resistance testing should be used to guide selection of an ARV regimen. A viral tropism assay should be performed before initiation of a CCR5 antagonist or at the time of virologic failure that occurs while a patient is receiving a CCR5 antagonist. HLA-B*5701 testing should be performed before initiation of abacavir. Patients should be screened for hepatitis B and hepatitis C virus infection before initiating ART and, if indicated, periodically after ART initiation, as treatment of these coinfections may affect the choice of ART. The rationale for and utility of some of these laboratory tests are discussed in the corresponding sections of the Guidelines.

References

  1. Aberg JA, Gallant JE, Ghanem KG, Emmanuel P, Zingman BS, Horberg MA. Primary care guidelines for the management of persons infected with HIV: 2013 update by the HIV medicine association of the Infectious Diseases Society of America. Clin Infect Dis. Jan 2014;58(1):e1-34. Available at http://www.ncbi.nlm.nih.gov/pubmed/24235263.
  2. Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents. 2017. Available at https://aidsinfo.nih.gov/guidelines/html/4/adult-and-adolescent-oi-prevention-and-treatment-guidelines/0.
  3. Lucas GM, Ross MJ, Stock PG, et al. Clinical practice guideline for the management of chronic kidney disease in patients infected with HIV: 2014 update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. Nov 1 2014;59(9):e96-138. Available at http://www.ncbi.nlm.nih.gov/pubmed/25234519.
  4. Jacobson TA, Ito MK, Maki KC, et al. National Lipid Association recommendations for patient-centered management of dyslipidemia: part 1--full report. J Clin Lipidol. Mar-Apr 2015;9(2):129-169. Available at http://www.ncbi.nlm.nih.gov/pubmed/25911072.

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