Page 21 - HIV/AIDS Guidelines

Table 3, continued. Laboratory Monitoring Schedule for Patients Prior to and After Initiation of
Antiretroviral Therapy

a
ARV modification may be done for treatment failure, adverse effects, or simplification.
b
If HIV RNA is detectable at 2–8 weeks, repeat every 4–8 weeks until suppression to <200 copies/mL, then every 3–6 months.
c
For adherent patients with suppressed viral load and stable clinical and immunologic status for >2–3 years, some experts may extend the
interval for HIV RNA monitoring to every 6 months.
d
For ART-naive patients, if resistance testing was performed at entry into care, repeat testing is optional; for patients with viral suppression
who are switching therapy for toxicity or convenience, resistance testing will not be possible and therefore is not necessary.
e
If HBsAg is positive at baseline or prior to initiation of ART, TDF + (FTC or 3TC) should be used as part of ARV regimen to treat both HBV and
HIV infections. If HBsAg and HBsAb are negative at baseline, hepatitis B vaccine series should be administered.
f 3
Serum Na, K, HCO , Cl, BUN, creatinine, glucose (preferably fasting); some experts suggest monitoring phosphorus while on TDF;
determination of renal function should include estimation of creatinine clearance using Cockcroft-Gault equation or estimation of glomerular
filtration rate based on MDRD equation.
g
For patients with renal disease, consult “Guidelines for the Management of Chronic Kidney Disease in HIV-Infected Patients:
1
Recommendations of the HIV Medicine Association of the Infectious Diseases Society of America”.
h
More frequent monitoring may be indicated for patients with increased risk of renal insufficiency, such as patients with diabetes,
hypertension, etc.
Acronyms: 3TC = lamivudine, ABC = abacavir, ALT = alanine aminotransferase, ART = antiretroviral therapy, AST = aspartate aminotranserase,
CBC = complete blood count, EFV = efavirenz, FTC = emtricitabine, HBsAb = hepatitis B surface antibody, HBsAg = hepatitis B surface antigen,
HBV = hepatitis B virus, MDRD = modification of diet in renal disease (equation), TDF = tenofovir, ZDV = zidovudine

References

1. Gupta SK, Eustace JA, Winston JA, et al. Guidelines for the management of chronic kidney disease in HIV-infected
patients: recommendations of the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis.
2005;40(11):1559-1585.

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents C-3

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