BC Centre in HIV/AIDS Primary Care Guidelines

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1.5 Non-Infectious Comorbidity Screening

ConditionAssessmentSpecific Assessment(s)Pre-ARV BaselineFollow-up on ARVComments
General Medical History Personal and family history premature cardiovascular disease, hypertension, diabetes, osteoporosis, liver disease, chronic kidney disease Annually or more often if identified high risk  
Concomitant medications Concomitant medications
Lifestyle smoking, alcohol, recreational drugs, diet, exercise
Addictions Substance Use Drug and alcohol intake Annually; quarterly if positive history See also: 5 Addictions and HIV
Bone disease Osteoporosis risk assessment family history, exercise, weight, smoking, alcohol, calcium and vitamin D intake Annually or more often if identified high risk
Fracture risk assessment CAROC or FRAX (Flash required)
Bone density DXA scan if age ≥50 years, history of fragility fracture, or post-menopausal

If normal at baseline, every 3 – 5 years (age ≥50 years)

If abnormal at baseline or if history of fracture, every 2 years

Cancer Anal cancer Digital rectal exam in MSM Every 1 – 3 years Anal Pap test may be considered where available, but not standard of care
Breast cancer Mammography Follow BC guidelines
Cervical cancer Pap test starting at age 21 or 3 years after first sexual contact, whichever occurs first Repeat at 6 months; if both tests normal, repeat annually See BC guidelines
Colorectal cancer FIT for men and women 50-74 years Every 2 years for men and women 50 – 74 years

See BC guidelines

Patients with abnormal FIT test should be referred for colonoscopy

Prostate cancer Digital rectal exam in men >50 years Every 1 – 3 years for men >50 years Use of the PSA test for screening is controversial
Cardiovascular disease Risk assessment Framingham risk score Annually or more often if identified high risk
BP BP Every 3 – 4 months initially, then every 6 months when stable
Fasting lipids total, HDL, and LDL cholesterol; triglycerides With first pVL (after 1 month), then every 6 months
Apolipoprotein B Apolipoprotein B Alternative to fasting lipids especially in patients with hypertriglyceridemia With first pVL (after 1 month), then every 6 months, as an alternative to fasting lipids especially in patients with hypertriglyceridemia
ECG ECG   At intervals determined by the degree of risk in patients taking PIs and/or rilpivirine with other PR- or QTc-prolonging drugs
Diabetes & Insulin Resistance Blood sugar Fasting blood glucose and/or glycated hemoglobin (HbA1c) with first pVL (after 1 month), then every 6 months
  • Hb A1C can be misleading in certain anemic conditions (e.g. iron deficiency)or asplenia or after recent transfusion, hemolysis, or blood loss

  • Manage blood glucose abnormalities per Canadian Diabetes Society Guidelines, with lifestyle changes first (weight loss, diet, exercise)

  • Potential interactions of antiglycemic agents with ARVs; see Drug Interaction Tables

Hematologic disease Blood cell counts CBC and differential with first pVL (after 1 month), then every 3 – 4 months initially, then every 6 months when stable  
Platelet count  
Hypogonadism Testosterone level Morning serum total testosterone level only in symptomatic men Only in symptomatic men
  • Normal morning serum total testosterone level should be confirmed with repeat testing
  • Estimated bioavailable testosterone measurement may be helpful to assess certain individuals, including obese men with borderline low total testosterone levels
Liver disease/Cirrhosis Viral hepatitis See 1.4 Coinfection Screening every 3 – 4 months initially, then every 6 months when stable  
Liver enzymes and liver function tests AST, ALT, total bilirubin, INR with first pVL (after 1 month), then every 3 – 4 months initially, then every 6 months when stable
Hepatocellular carcinoma screen Abdominal ultrasound for individuals who are co-infected with HBV and/or HCV every 6 months for patients with HBV (regardless of fibrosis stage), or with HCV and cirrhosis
Screen for esophageal varices Gastrocopy for individuals with cirrhosis  
Lung disease Lung cancer and COPD Chest X-ray As clinically indicated
  • Consider chest CT, especially in smokers
  • Smoking cessation should be encouraged in all patients
  • A diagnosis of COPD should be considered, and spirometry performed as a screening test, patients presenting with persistent respiratory complaints, especially those with additional risk factors such as smoking
  • COPD should be managed according to current Canadian Thoracic Society guidelines
  • Concomitant use of inhaled steroids with ritonavir or cobicistat should be avoided if possible
Lung function Spirometry In patients with persistent respiratory complaints In patients with persistent respiratory complaints
Renal disease Risk assessment Family history, race, age , diabetes, hypertension, hepatitis B/C, other liver disease, concomitant nephrotoxic medications including NSAIDs and recreational drugs Annually or more often if identified high risk
  • Increased risk for renal disease associated with black race, age ≥50 years, advanced HIV disease (low CD4 nadir), and certain antiretrovirals, particularly tenofovir DF and indinavir, also possibly with atazanavir, lopinavir/ritonavir

BP BP every 3 – 4 months initially, then every 6 months when stable
Renal function, urinalysis Serum creatinine and eGFR; serum phosphate; urinalysis; spot urine for albumin to creatinine ratio with first pVL (after 1 month), then every 3 – 4 months initially, then every 6 months when stable

Other screening and health maintenance interventions may be indicated depending on the age and gender of the patient. See also: The Canadian Guide to Clinical Preventive Health Care

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