- HIV test - If there is no documented HIV test at the initial visit one should be obtained. Also, if there is a documented test and the patient has a viral load less than 50 and a normal CD4 count, a repeat HIV test should be obtained at the initial visit.
- CD4 (T-cell) count - In the asymptomatic patient, a CD4 count should be drawn at least every 3-6 months. If the patient is having symptoms or illness, CD4 counts should be drawn more frequently.
- Viral load - In the asymptomatic patient, a viral load should be drawn every 3-4 months. When the patient begins a new drug regimen, the viral load should be assessed every 4-8 weeks until the viral load is less than 50 then every 3-4 months thereafter.
- Sexually Transmitted Diseases Screening (STDs) - STD screenings that include syphilis (RPR), VDRL, chlamydia, and gonorrhea should be done at the initial visit and repeated if:
- the patient reports at risk sexual behaviors
- the patient has symptoms of STDs
- tha patient has other existing STDs
- or if there is an increased prevalence of STDs in the patient's community or social group.
- Liver Function Studies (LFTs) - LFTs should be assessed at the initial visit. After the patient begins a medication regimen, the LFTs should be assessed more frequently depending on the drugs. For instance if the patient is on a regimen containing Viramune the LFTS should be assessed every 2 weeks for the first 8-12 weeks after the medication regimen is started. obviously, LFTs should be drawn more often if signs or symptoms of liver damage or infection are present.
- Complete Blood Count and Electrolyte Panel (CBC and LYTES) - CBC and LYTES should be assessed at the initial visit and regularly thereafter. The frequency of these blood tests will increase if the patient is sick of if the patient is taking a drug regimen that can alter these studies.
- Drug Resistance Studies (HIV genotype) - Because HIV resistance can be passed from one person to another, those people newly infected should have resistance testing. In addition, those patients who have never been on HIV medications and have been infected 2 years or less should also have their genotype assessed. Finally, genotype testing should be done for those patients showing signs of virologic failure to their current drug regimen.
- TB Testing - A TB skin test should be obtained at the initial visit for all HIV infected patients. Annual TB tests should be considered for those patients at high risk for exposure (e.g., the homeless, those incarcerated, those living in areas of high TB prevelance). A TB test should always be done if there is a suspicion of recent exposure of there are symptoms of TB. Finally, repeat TB tests should be done for those people who have had negative test in the past that may be due to a suppressed immune response. As their CD4 rises and the immune response returns to normal, a repeat test is necessary to confirm previous negative tests were not due to their suppressed immune response.
- PAP Smears - HIV infected women should have a PAP smear as part of their initial evaluation. If the results are normal, a PAP test should be done each year. More frequent PAP tests should be done under these circumstances:
- an abnormal PAP test
- a previous history of abnormal PAP tests
- symptomatic HIV infection
- after treatment for an abnormal PAP
- documented HPV infection
- Mammogram - There has been no evidence that breast cancer has an increased prevalence in HIV infected women. Therefore, women with HIV should get mammograms according to standard guidelines:
- every 1-2 years in women 40-50 years old
- before the age of 40 in women with a history of breast cancer or a family history of breast, ovarian cancer, or with abnormal findings in a routine breast exam
- yearly in women older than 50
- Colon Screenings - Depending on the risk factors present, colon screening should be on a regular basis.
- High risk patients such as those with a family history of colon cancer, diseases that increase the risk of colon cancer such as ulcerative colitis, or with compromised immune systems such as HIV should have a yearly fecal occult blood screening and sigmoidoscope and a colonoscopy every 5 to 10 years. At age 50 or 10 years after a diagnosis of high risk diseases such as ulcerative colitis or colon cancer in another family member, a colonoscopy should be done every 1 to 2 years.
- f there are any signs or symptoms such as rectal bleeding, a screening should be done immediately and then every 6 months to a year until the problem is resolved.
- In healthy people without risks, disease, or symptoms, a yearly fecal occult blood test, a sigmoidoscope every 5 years, and a colonoscopy every 10 years starting at age 50 is recommended.
Source: Aberg, J. "Primary Care Guidelines for the Management of Persons Infected with Human Immunodeficiency Virus", 2004.