View source for Initial assessment for patients with HIV

==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==

*[http://occguidelines.com/guidelines/ 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: [https://doi.org/10.1093/cid/cit665 10.1093/cid/cit665]

[[Category:HIV]]