Initial assessment for patients with HIV: Difference between revisions

Latest revision as of 15:10, 30 April 2021

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

@@ Line 1: / Line 1: @@
-== History ==
+==History==
-* Date and context of diagnosis
+*Date and context of diagnosis
-* History of [[Opportunistic infections in HIV]]
+*History of [[Opportunistic infections in HIV]]
-* Sexual history
+*Sexual history
-== Investigations ==
+==Investigations==
-* HIV-specific
+*HIV-specific
-** CD4/CD8 count
+**CD4/CD8 count
-** HIV-RNA viral load
+**HIV-RNA viral load
-** HIV genotype
+**HIV genotype
-** HLA *B5701 genotyping (for abacavir)
+**HLA *B5701 genotyping (for abacavir)
-** Genetic resistance assays (± tropism testing for CCR5 inhibitors)
+**Genetic resistance assays (± tropism testing for CCR5 inhibitors)
-** G6PD deficiency
+**G6PD deficiency
-* Routine
+*Routine
-** CBC, lytes, creatinine
+**CBC, lytes, creatinine
-** Fasting lipids, Hb A1c
+**Fasting lipids, Hb A1c
-** Urinalysis (glucose and protein)
+**Urinalysis (glucose and protein)
-** Consider bone mineral density testing and vitamin D levels
+**Consider bone mineral density testing and vitamin D levels
-* STIs and coinfections
+*STIs and coinfections
-** TB skin test
+**TB skin test
-** Consider chest x-ray
+**Consider chest x-ray
-** HAV-IgG, HBV-sAg/sAb/cAb, and HCV-Ab
+**HAV-IgG, HBV-sAg/sAb/cAb, and HCV-Ab
-** Syphilis
+**Syphilis
-** Three-site mucosal (genital/rectal/throat) NAAT for chlamydia and gonorrhea
+**Three-site mucosal (genital/rectal/throat) NAAT for chlamydia and gonorrhea
-** Toxoplasma, varicella, CMV, and measles serologies
+**Toxoplasma, varicella, CMV, and measles serologies
-* For women and trans men
+*For cis women and trans men
-** Pap smear
+**Pap smear
-** Rubella serology
+**Rubella serology
-** Trichomonas testing
+**Trichomonas testing
+*Low threshold for CT chest/abdo/pelvis for lymphadenopathy and non-tuberculous mycobacteria in patients with low CD4 counts
-== Initial regimens ==
+== Physical Examination ==
+* Assess for cutaneous Kaposi sarcoma
-* All are integrase inhibitor with two nucleoside analogues
-* Consider one of the [[single-tablet regimens for HIV]]
+==Initial Regimens==
-** Triumeq (if HLA B5701 negative): dolutegravir, abacavir, and lamivudine
-** Truvada (tenofovir/TDF and emtricitabine) with either dolutegravir or raltegravir
+*All are integrase inhibitor with two nucleoside analogues
-** Stribild: elvitegravir/cobicistat/tenofovir disoproxil/emtricitabine
+*Consider one of the [[single-tablet regimens for HIV]]
-** Complera: emtricitabine/rilpivirine/tenofovir disoproxil
+**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]]