Initial assessment for patients with HIV

From IDWiki



  • 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