Routine follow-up for patients with HIV

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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.