Routine follow-up for patients with HIV
From IDWiki
| Intervention | Recommendation | Comments |
|---|---|---|
| Blood pressure check | Perform annually in all patients | |
| Digital rectal exam | Consider annually in all patients | Inspect for anal warts, malignancy, prostate abnormalities in men |
| Ophthalmologic exam | Perform dilated exam every 6–12 mo in patients with a CD4 count <50 cells/µL | Exam with tonometry is advised every 2-3 y in all patients ≥50 y |
| Depression screening | Perform annually in all patients | Use conventional mental health interview or standardized test |
| Fasting glucose and/or HbA1c | Perform every 6–12 mo in all patients | Consider testing 1–3 mo after starting or modifying antiretroviral therapy. HbA1c may be used for screening. Consider threshold cutoff of 5.8%. HbA1c level should be performed every 6 mo in patients with diabetes mellitus |
| Fasting lipid profile | Perform every 6–12 mo in all patients | Consider testing 1–3 mo after starting or modifying antiretroviral therapy |
| Syphilis serology | Perform annually in patients at risk for STDs | More frequent testing may be indicated in patients at high risk for STDs |
| Gonorrhea and chlamydia testing | Perform annually in patients at risk for STDs (see text for details) | More frequent testing may be indicated in patients at high risk for STDs. Repeat testing 3 mo later if positive |
| Hepatitis C testing | Perform annually in patients at risk, eg, injection drug users and MSM | More frequent testing may be indicated in patients at high risk, especially if increase in serum transaminases |
| Trichomoniasis | Perform annually in all women | Repeat testing 3 mo later if positive |
| TST or IGRA | Perform at baseline and annually in patients at risk for tuberculosis | No need to repeat in patients with prior positive TST; additional tuberculosis testing may be indicated depending on potential exposure |
| Colorectal cancer screening | Perform at age 50 y in asymptomatic patients at average risk | More frequent testing is indicated in patients with a history of adenomatous polyps; testing at an earlier age may be advised in patients with a strong family history of colon cancer |
| Mammography | Perform annually in all women age ≥50 y | Some authorities advise initiation of screening starting at age 40 y based on an individual risk/benefit assessment |
| Cervical Pap smear | Perform annually in all women after 2 normal Pap tests documented during the first year following HIV diagnosis | |
| Bone densitometry | Perform baseline exam in postmenopausal women and men age ≥50 y | Detection of premature bone loss requires periodic monitoring thereafter; risk factors for premature bone loss include white race, small body habitus, sedentary lifestyle, cigarette smoking, alcoholism, phenytoin therapy, corticosteroid therapy, hyperparathyroidism, vitamin D deficiency, thyroid disease, and hypogonadism |
| Abdominal ultrasonography | Perform once in men aged 65–75 y who have ever smoked | Screening test for abdominal aortic aneurysm |
| Patient education | Address regularly in all patients | Issues may include sexual behavior, alcohol and drug counseling, dietary teaching, weight reduction, smoking cessation, and seat belt use. |
Further Reading
- 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. 2014 Jan;58(1):e1-34. doi: 10.1093/cid/cit665.
