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Entering HIV Treatment

June 26, 2009

Each HIV-infected patient initially entering into care should have a complete medical history, physical examination, laboratory evaluation, and counseling. The purpose is to confirm the presence of HIV infection, obtain appropriate baseline historical and laboratory data, assure patient understanding about HIV infection, and initiate care as recommended by the HIV primary care guidelines and by the opportunistic treatment and prevention guidelines. Baseline information then is used to define management goals and plans.

The following laboratory tests should be performed for a new patient during initial patient visits:

•  HIV antibody testing (if prior documentation not available) or if HIV RNA is undetectable (AI);
•  CD4 T-cell count (AI);
– 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-? release assay
(IGRA) (unless there is a history of prior tuberculosis or positive TST or IGRA), anti-Toxoplasma gondii IgG,
hepatitis A, B, and C serologies, and Pap smear in women (AIII);
• Fasting blood glucose and serum lipids if the patient is considered at risk for cardiovascular 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).

People living with HIV/AIDS must often deal with several social, psychiatric, and health related issues that are best
adressed with a multidisciplinary approach to HIV. The evaluation also must include assessment of
drug 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.

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