BC Centre in HIV/AIDS Primary Care Guidelines

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6 Schedule of Assessments and Procedures

Baseline

  • History and PE (including weight and BP), including
    • Assess risk for CVD, CKD, DM, osteoporosis/fractures
    • Assess mental health, substance use
    • Pregnancy plans and contraception issues
    • TB history and past exposure, previous CXR and TST and/or IGRA results
    • Social circumstances and support network
  • abdominal ultrasound if coinfected with HBV and/or HCV
  • ALT, AST, total BR, INR
  • CBC, differential, platelets
  • Creatinine, eGFR, serum phosphate, urinalysis, UACR (or PCR)
  • CXR
  • DXA for bone density if ≥50 years, history of fragility fracture, or post-menopausal
  • Fasting glucose or HbA1C
  • Fasting lipids (TG, TC, HDL, LDL) or apoB
  • FIT if age 50-74 years
  • HAV Ab, total
  • HBV serology and HBV-DNA if indicated
  • HCV Ab, HCV RNA if Ab+
  • HIV-specific tests
    • HIV serology (if not already available)
    • CD4 cell count (absolute and percentage)
    • HIV plasma viral load (quantitative HIV RNA PCR)
    • HIV genotypic drug resistance
    • HLA-B*5701
    • Tropism testing — if considering use of a CCR5 antagonist
  • Mammogram per BC guidelines
  • NAAT for gonorrhea and chlamydia
  • Pap (cervical)
  • Swabs for trichomonas, bacterial vaginosis, herpes
  • Syphilis EIA
  • Toxoplasma IgG
  • TST using PPD or IGRA
  • Vaccines
    • Pneumococcal vaccine
    • Influenza vaccine (seasonal)
    • Td/TdaP
    • Hepatitis A (if total HAV Ab )
    • Hepatitis B (if HBAb )
    • MMR — non-pregnant, non-immunocompromized adults (CD4 >200)
    • Varicella — non-pregnant, non-immunocompromized adults (CD4 >200)

Every 3 – 6 months

If clinically stable and on ARVs (may be done more often if clinically unstable and/or not on ARVs):

  • Assess symptoms
  • Assess substance use (drugs and alcohol) if positive history
  • weight
  • BP
  • CBC and differential, platelet count
  • Liver enzymes (ALT, AST) and liver function (total BR, INR)
  • Renal function (Cr, eGFR, phosphate, urinalysis, urine ACR or PCR)
  • STI screen: Syphilis EIA, NAAT for gonorrhea and chlamydia, swabs for trichomonas, bacterial vaginosis, herpes — if ongoing STI risk behaviours
  • VL, CD4

Every 6 months

  • Abdominal ultrasound if HCV+ and cirrhosis, or HBV+ regardless of fibrosis stage
  • First followup Pap if negative at baseline
  • Ophthalmologic exam if CD4 <50
  • Reassess risk of CVD, CKD, DM, OP if high risk identified previously
  • Fasting glucose or HbA1C
  • Fasting lipids (TG, TC, HDL, LDL) or apoB

Annually

  • PE including weight and BP
  • Reassess symptoms
  • HAV Ab - if negative at baseline, ongoing risk activities or elevated liver enzymes, and not immunized
  • HBV serology - if negative at baseline, ongoing risk activities or elevated liver enzymes, and not immunized
  • HCV Ab - if negative at baseline and ongoing risk activities or elevated liver enzymes
  • Influenza vaccine
  • Pap (after first 2 negative 6 months apart)
  • Reassess risk of CVD, CKD, DM, OP
  • Reassess mental health, substance use
  • Reassess pregnancy plans, contraception
  • Reassess social circumstances and support network
  • STI screen
  • TST using PPD or IGRA if previously negative

Less than annually

  • Chest X-ray when clinically indicated
  • DXA for bone density every 3 – 5 years if age ≥50 years, or every 2 years if baseline abnormal or history of fracture
  • FIT every 2 years if age 50 – 74 years
  • Mammogram per BC guidelines
  • Pneumococcal vaccine 5 years after first dose
  • Td booster every 10 years

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