HIV in adults

Monitoring is recommended after initiation or modification of antiretroviral therapy (ART) to assess the virological and immunological efficacy of ART and to monitor for laboratory abnormalities that may be associated with antiretroviral drugs. The following laboratory testing is recommended after initiation of ART.[78]US Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents living with HIV. Sep 2024 [internet publication]. https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-arv/whats-new-guidelines

• CD4 count: every 3 months (if CD4 count <300 cells/microlitre) or 6 months (if CD4 count is ≥300 cells/microlitre) during the first 2 years. After 2 years on ART with consistently suppressed viral load, monitor every 6 months (CD4 count remains <300 cells/microlitre), 12 months (CD4 count consistently 300-500 cells/microlitre), or optional (CD4 count consistently ≥500 cells/microlitre). Also recommended if treatment failure, clinically indicated, or every 3-6 months if ART is delayed.

• HIV viral load: 4-8 weeks after ART initiation/modification. If HIV RNA is detectable at 4-8 weeks, repeat testing every 4-8 weeks until viral load is suppressed to <50 copies/mL. Thereafter, repeat testing every 3-6 months (every 3 months during the first 2 years of ART, then can extend to every 6 months for patients with consistent viral suppression ≥2 years). More frequent monitoring may be considered in individuals who are having difficulties with ART adherence. Also recommended if treatment failure, clinically indicated, or if ART is delayed (repeat testing is optional).

• Resistance testing (reverse transcriptase and protease genes): only recommended if treatment failure, clinically indicated, or if ART is delayed.

• Resistance testing (integrase genes): only recommended if treatment failure or clinically indicated (if there is a history of integrase strand transfer inhibitor use).

• Tropism testing: only recommended if treatment failure (if considering a CCR5 antagonist or patients with virological failure on a CCR5 antagonist) or clinically indicated.

• Hepatitis B screening: if clinically indicated only (e.g., before starting direct-acting antivirals for hepatitis C virus infection).

• Basic metabolic panel: 4-8 weeks after ART initiation/modification, and then every 6 months. Also recommended if clinically indicated or every 6-12 months if ART is delayed.

• Liver function tests: 4-8 weeks after ART initiation/modification, and then every 6 months. Also recommended if clinically indicated or every 6-12 months if ART is delayed.

• Full blood count with differential: every 3-6 months initially (when monitoring CD4 count), and then every 12 months (when no longer monitoring CD4 count). Also recommended if clinically indicated.

• Lipid profile: consider 1-3 months after ART initiation or modification, and then every 12 months (if normal at baseline but with cardiovascular risk). Also recommended if clinically indicated (if normal at baseline, every 5 years if clinically indicated).

• Random or fasting glucose level: if clinically indicated or treatment failure.

• Urinalysis: if clinically indicated only (e.g., patients with diabetes mellitus or chronic kidney disease).

• Pregnancy test: if clinically indicated only.

Adherence to ART should be regularly assessed at every clinic visit.