Initial assessment for patients with HIV
From IDWiki
History
- Date and context of diagnosis
- History of Opportunistic infections in HIV
- Sexual history
Investigations
- HIV-specific
- CD4/CD8 count
- HIV-RNA viral load
- HIV genotype
- HLA *B5701 genotyping (for abacavir)
- Genetic resistance assays (± tropism testing for CCR5 inhibitors)
- G6PD deficiency
- Routine
- CBC, lytes, creatinine
- Fasting lipids, Hb A1c
- Urinalysis (glucose and protein)
- Consider bone mineral density testing and vitamin D levels
- STIs and coinfections
- TB skin test
- Consider chest x-ray
- HAV-IgG, HBV-sAg/sAb/cAb, and HCV-Ab
- Syphilis
- Three-site mucosal (genital/rectal/throat) NAAT for chlamydia and gonorrhea
- Toxoplasma, varicella, CMV, and measles serologies
- For cis women and trans men
- Pap smear
- Rubella serology
- Trichomonas testing
- Low threshold for CT chest/abdo/pelvis for lymphadenopathy and non-tuberculous mycobacteria in patients with low CD4 counts
Physical Examination
- Assess for cutaneous Kaposi sarcoma
Initial Regimens
- All are integrase inhibitor with two nucleoside analogues
- Consider one of the single-tablet regimens for HIV
- Biktarvy 1 tablet PO once daily
- Triumeq (if HLA B5701 negative): dolutegravir, abacavir, and lamivudine
- Truvada (tenofovir/TDF and emtricitabine) with either dolutegravir or raltegravir
- Stribild: elvitegravir/cobicistat/tenofovir disoproxil/emtricitabine
- Complera: emtricitabine/rilpivirine/tenofovir disoproxil
- Don't forget to add TMP-SMX DS 1 tablet PO daily if presumed low CD4 count
Further Reading
- Clinical Care Guidelines for Adults and Adolescents Living with HIV in Ontario, Canada
- Primary Care Guidelines for the Management of Persons Infected With HIV: 2013 Update. Clin Infect Dis. 2014:58(1):e1–e34. doi: 10.1093/cid/cit665