BC Centre in HIV/AIDS Primary Care Guidelines

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2.3 Monitoring

 TestBaselineBefore ARV InitiationAfter ARV InitiationAfter 2 years, clinically stable with dependable ARV therapy adherenceSee also
Anal Dysplasia/Cancer Screen Anal Pap smear
  • Not current standard of care
  • Being performed in HIV+ women and MSM in some health centres
1.4 Co-Infection Screening
4 Women and Transgender Individuals with HIV
Blood Glucose Fasting glucose or glycated hemoglobin (HbA1C) Annually if stable with first pVL  (after 1 month), then every 6 months Every 6 months 1.5 Non-Infectious Comorbidity Screening
Bone Density Screen 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

1.5 Non-Infectious Comorbidity Screening
4 Women and Transgender Individuals with HIV
Breast Cancer Screen Screening mammogram Follow BC guidelines Follow BC guidelines 4 Women and Transgender Individuals with HIV
Screening Mammography Program
CD4 Count CD4 count, absolute and percentage Every 3 – 4 months Monthly until pVL <40 copies/mL then every 3 – 4 months Every 6 months; optional if consistently ​>​350 cells/µL 1.3 HIV-Specific Tests
Cervical Cancer Screen Pap smear starting at age 21 or 3 years after first sexual contact, whichever occurs first 6 months after baseline; if normal, repeat annually

4 Women and Transgender Individuals with HIV

BC Guidelines

Chest X-ray Chest X-ray When clinically indicated 1.4 Co-Infection Screening
Fasting Lipid Profile Total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides; or apoB Annually if stable with first pVL (after 1 month), then every 6 months Every 6 months 1.5 Non-Infectious Comorbidity Screening
Hematologic Assessment CBC with Differential, Platelet count Every 3 – 4 months

with first pVL (after 1 month), then every 3-4 months

HIV Infection Status HIV antibody diagnostic test (ELISA, Western blot) if not already available       1.3 HIV-Specific Tests
Liver Enzymes & LFTs ALT, AST, Total bilirubin, INR Annually if stable with first pVL (after 1 month), then every 3 – 4 months  Every 6 months 1.5 Non-Infectious Comorbidity Screening
Renal Function Blood pressure, Creatinine, eGFR, Serum phosphate, Urinalysis, Spot urine ACR or PCR Annually if stable; increase frequency if baseline renal dysfunction or high risk of chronic kidney disease

labs with first pVL(after 1 month), then every 3 – 4 months; increase frequency if baseline renal dysfunction or high risk of chronic kidney disease

Every 6 months; increase frequency if baseline renal dysfunction or high risk of chronic kidney disease
Resistance Testing HIV genotypic drug resistance (At the time of first pVL; can be done on stored plasma sample) Shortly before ARV initiation Test if pVL rebounds (to >250 copies/mL) after initial suppression or pVL fails to suppress to <250 copies/mL  Test if pVL rebounds to >250 copies/mL 1.3 HIV-Specific Tests
Screen For Risk Of ABC HSR HLA-B*5701 Before initiating or restarting therapy with abacavir, if not previously done.
  • Test patients not previously screened and currently taking abacavir
  • Patients stopping abacavir therapy who are HLA-B*5701 positive are at a high risk of HSR and should not restart abacavir therapy
 
  • Test patients not previously screened and currently taking abacavir
  • Patients stopping abacavir therapy who are HLA-B*5701 positive are at a high risk of HSR and should not restart abacavir therapy
STI Screen NAAT for gonorrhea and chlamydia (first-morning urine in men, cervical swab or urine specimen in women and transgender individuals with a cervix); swabs for trichomonas, bacterial vaginosis, herpes Annually, or every 3 – 6 months if ongoing risk behaviours, or if symptoms present 1.4 Co-Infection Screening
4 Women and Transgender Individuals with HIV
Syphilis Screen EIA 1.4 Co-Infection Screening
TB Screen (TST) Chest x-ray and TST using PPD; IGRA adjunct test if: a) TST and CD4<200 cells/µL, or b) TST and a history of contact with active TB unless contraindicated; repeat TST in patients with advanced HIV when CD4 increases to >200 cells/µL Annually if baseline TST is negative but at ongoing risk for TB, or more often if there is evidence of new exposure to TB
Toxoplasmosis Screen Toxoplasma IgG Ab  When indicated by CNS symptoms
Tropism Testing Coreceptor tropism testing   When considering a CCR5 antagonist When considering a CCR5 antagonist as an ARV switch or for treatment failure  When considering a CCR5 antagonist as an ARV switch or for treatment failure 1.3 HIV-Specific Tests
Viral Hepatitis Screen Total Anti-HAV Ab; HBsAg, anti-HBs, and anti-HBc; HBV DNA if HBsAg, anti-HBs, and anti-HBc+; Anti-HCV Ab, HCV RNA if HCV Ab+ Annually if at baseline and ongoing risk or unexplained elevated liver enzymes 1.4 Co-Infection Screening
Viral Load Quantitative plasma HIV RNA Every 3 – 4 months Monthly until pVL <40 copies/mL then every 3 – 4 months  Every 6 months 1.3 HIV-Specific Tests

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